Medical Student Southern Illinois University School of Medicine Springfield, Illinois, United States
Background: In the emergency department (ED), procedural sedation is used for various painful procedures such as laceration repair and fracture reductions. In the pediatric population, this is especially important to ensure the procedure can be performed in a safe manner for anxious children who are unable to stay still or cannot tolerate painful procedures. Common drug regimens are ketamine alone or ketamine with propofol. However, studies have shown respiratory adverse events with ketamine use despite its ability to preserve breathing reflexes. Administering propofol and ketamine in combination allows for lower dosages of each drug, and these two agents counteract each other’s side effects. Objective: This study will determine if first administering a single dose of ketamine followed by tight titrations of propofol results in significantly less adverse effects and significantly shorter recovery times compared to administering ketamine alone for pediatric procedural sedation in a single community hospital. Design/Methods: This study was approved by the Southern Illinois University School of Medicine IRB as exempt (#23-277). We will be conducting a retrospective chart review on pediatric patients who presented to a single community hospital from 2017 to 2022 and underwent a painful procedure (i.e. fracture reduction and/or laceration repair). Patient demographics will be recorded as well as the indication for the procedure; drug(s) and dosage(s); any adverse event(s); time of the first dose; the start and end times of each procedure; and the stoppage of frequent vital sign documentation. Descriptive summary statistics will be computed for all variables. Patients receiving ketamine alone will be compared to those receiving ketamine and propofol in combination. Associations of sedation group with categorical variables (i.e. gender/complications) will be examined via Chi-square; differences of continuous variables (BMI, duration, recovery time) will be tested with t-test or nonparametric equivalent. P-values less than 0.05 will be considered statistically significant.
