Progress of sedation and analgesia in the pediatric emergency department_West China Medical Journal

Authors：

WANG Xinglei ,  ZHANG Shu

Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

ZHANG Shu, Email: zhangs@wchscu.cn

Keywords：

Emergency; Child; Sedation; Analgesia

DOI：

10.7507/1002-0179.202006008

Video：

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Abstract Full text Figures/Tables Video References Cited by

Sedation and analgesia is an essential part of the emergency work. Presently, for adults, clinical assessment and application of sedation and analgesia has been gradually perfect, but in the face of pediatric patients, clinicians would always concern drug-related adverse reactions as well as a variety of uncontrollable factors, leading to reducing and even ignoring the sedation and analgesia in children. This review focuses on the current research status and relevant evidence of pediatric sedation depth and risk assessment, pain assessment, as well as the principles, application methods, advantages and disadvantages of various commonly used clinical drugs, and the aim is to provide evidence for higher quality sedation and analgesia for children.

Citation： WANG Xinglei, ZHANG Shu. Progress of sedation and analgesia in the pediatric emergency department. West China Medical Journal, 2020, 35(11): 1391-1398. doi: 10.7507/1002-0179.202006008 Copy

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2. Trottier ED, Ali S, Le May S, et al. Treating and reducing anxiety and pain in the paediatric emergency department: the TRAPPED survey. Paediatr Child Health, 2015, 20(5): 239-244.
3. Cunningham ME, Vogel AM. Analgesia, sedation, and delirium in pediatric surgical critical care. Semin Pediatr Surg, 2019, 28(1): 33-42.
4. Chen J, Gadi GU, Panigrahy A, et al. Using neuroimaging to study the effects of pain, analgesia, and anesthesia on brain development. J Neurosurg Anesthesiol, 2019, 31(1): 119-121.
5. McCoy S, Lyttle MD, Hartshorn S, et al. A qualitative study of the barriers to procedural sedation practices in paediatric emergency medicine in the UK and Ireland. Emerg Med J, 2016, 33(8): 527-532.
6. Ramalho CE, Bretas PMC, Schvartsman C, et al. Sedation and analgesia for procedures in the pediatric emergency room. J Pediatr (Rio J), 2017, 93(Suppl 1): 2-18.
7. American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology, 2002, 96(4): 1004-1017.
8. International Association for Study of Pain. IASP terminology. (2017-12-14)[2020-11-01]. https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1698#Pain.
9. Zieliński J, Morawska-Kochman M, Zatoński T. Pain assessment and management in children in the postoperative period: a review of the most commonly used postoperative pain assessment tools, new diagnostic methods and the latest guidelines for postoperative pain therapy in children. Adv Clin Exp Med, 2020, 29(3): 365-374.
10. 林紫, 郑显兰, 沈巧. 小儿疼痛评估的研究进展. 全科护理, 2019, 17(25): 3098-3101.
11. Lawrence J, Alcock D, McGrath P, et al. The development of a tool to assess neonatal pain. Neonatal Netw, 1993, 12(6): 59-66.
12. Hummel P. Psychometric evaluation of the Neonatal Pain, Agitation, and Sedation (N-PASS) scale in infants and children up to age 36 months. Pediatric Nursing, 2017, 43(4): 175-184.
13. Choueiry J, Reszel J, Hamid JS, et al. Development and pilot evaluation of an educational tool for the flacc pain scale. Pain Manag Nurs, 2020, 15(20): 1524-9042.
14. Freund D, Bolick BN. CE: assessing a child’s pain. Am J Nurs, 2019, 119(5): 34-41.
15. Fein JA, Zempsky WT, Cravero J, et al. Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics, 2012, 130(5): e1391-e1405.
16. Noble J, Zarling B, Geesey T, et al. Analgesia use in children with acute long bone fractures in the pediatric emergency department. J Emerg Med, 2020, 58(3): 500-505.
17. Day LM, Huang R, Okada PJ. Management of pain after pediatric trauma. Pediatr Emerg Care, 2020, 36(2): 33-37.
18. Aguilar de la Red Y, Manrique Martín G, Guerrero Marquez G, et al. Assessment of orofacial pain management in a pediatric emergency department and at home after discharge. Arch Argent Pediatr, 2018, 116(1): 28-34.
19. Mataftsi A, Malamaki P, Prousali E, et al. Safety and efficacy of chloral hydrate for procedural sedation in paediatric ophthalmology: a systematic review and meta-analysis. Br J Ophthalmol, 2017, 101(10): 1423-1430.
20. Fong CY, Tay CG, Ong LC, et al. Chloral hydrate as a sedating agent for neurodiagnostic procedures in children. Cochrane Database Syst Rev, 2017, 11(11): CD011786.
21. Paparella SF. Chloral hydrate: safety risks still worth mentioning. J Emerg Nurs, 2018, 44(1): 81-83.
22. 王倩, 许静, 季兴. 门诊患儿安全应用水合氯醛镇静的经验. 药学与临床研究, 2018, 26(1): 63-65.
23. Haselkorn T, Whittemore AS, Udaltsova N. Short-term chloral hydrate administration and cancer in humans. Drug Saf, 2006, 29(1): 67-77.
24. Cozzi G, Norbedo S, Barbi E. Intranasal dexmedetomidine for procedural sedation in children, a suitable alternative to chloral hydrate. Paediatr Drugs, 2017, 19(2): 107-111.
25. Yuen VM, Li BL, Cheuk DK, et al. A randomised controlled trial of oral chloral hydrate vs. intranasal dexmedetomidine before computerised tomography in children. Anaesthesia, 2017, 72(10): 1191-1195.
26. Ganigara M, Srivastava S, Malik P, et al. Comparison of chloral hydrate and pentobarbital sedation for pediatric echocardiography. Echocardiography, 2019, 36(4): 766-769.
27. Krieser D, Kochar A. Paediatric procedural sedation within the emergency department. J Paediatr Child Health, 2016, 52(2): 197-203.
28. Martin HA, Noble M, Wodo N. The benefits of introducing the use of nitrous oxide in the pediatric emergency department for painful procedures. J Emerg Nurs, 2018, 44(4): 331-335.
29. Olsen A, Iversen C, Størdal K. Use of nitrous oxide in children. Tidsskr Nor Laegeforen, 2019, 139(12): 10.4045/tidsskr. 18.0338.
30. Pedersen RS, Bayat A, Steen NP, et al. Nitrous oxide provides safe and effective analgesia for minor paediatric procedures--a systematic review. Dan Med J, 2013, 60(6): A4627.
31. Seiler M, Staubli G. Ketamine procedural analgosedation before and after introducing nitrous oxide 70% in a paediatric emergency department. Swiss Med Wkly, 2019, 149: w20027.
32. Míguez MC, Ferrero C, Rivas A, et al. Retrospective comparison of intranasal fentanyl and inhaled nitrous oxide to intravenous ketamine and midazolam for painful orthopedic procedures in a pediatric emergency department. Pediatr Emerg Care, 2019.
33. Hoeffe J, Doyon TE, Bailey B, et al. Intranasal fentanyl and inhaled nitrous oxide for fracture reduction: the FAN observational study. Am J Emerg Med, 2017, 35(5): 710-715.
34. Seiler M, Staubli G, Landolt MA. Combined nitrous oxide 70% with intranasal fentanyl for procedural analgosedation in children: a prospective, randomised, double-blind, placebo-controlled trial. Emerg Med J, 2019, 36(3): 142-147.
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