Adverse Events during Sedation for Oro-Dental Trauma in Rambam Pediatric Emergency Department

There is paucity of data on the safety of the practice of sedation for oro-dental trauma in the pediatric emergency department (ED). A previous study reported the safety of intramuscular ketamine administered as a single agent. In the pediatric ED of Rambam Health Care Campus in Haifa, Israel, one of two regimens are used for sedating injured children as per physician discretion, intramuscular ketamine as a single agent or the combination of ketamine and propofol intravenously. The aim of this study was to assess the safety of ketamine-propofol sedation in children undergoing oro-dental injuries in this paediatric ED. The primary outcome of the study was sedation adverse events that require intervention (SARI): prolonged oxygen desaturation and apnea, laryngospasm, hypotension, bradycardia, partial or complete airway obstruction, and pulmonary aspiration. During the 2-year study period 17 children were sedated with ketamine-propofol, 20 with ketamine alone, and 29 with N2O. Patients who were treated with ketamine-based sedation and N2O sedation had a median (interquartile range, IQR) age of 3 (2-4) years, and 7 (5-9) years, respectively. No SARI occurred in patients who were sedated with ketamine alone. One (3.4%) SARI was reported in a patient who was sedated with N2O. Six/17 (35%) SARI occurred in patients who were treated with ketamine-propofol sedation. The findings osuggest that caution should be used when young children with oro-dental injuries are treated with ketamine-propofol sedation in the ED.