INTRAVENOUS SEDATION FOR THE CLOSED REDUCTION OF FRACTURES IN CHILDREN

The safety and efficacy of intravenous sedation with both a narcotic a nd a benzodiazepine were evaluated in 104 consecutive children who had closed reduction of a fracture. Six patients had a subsequent additio nal reduction with intravenous sedation, so the study involved a total of 110 procedures. The average dose of meperidine was 1.47 milligrams per kilogram of body weight, and the average dose of midazolam was 0. 11 milligram per kilogram of body weight. The interval between inducti on of the sedation and performance of the procedure averaged ten minut es, and the total duration of the procedure averaged thirty-nine minut es. There were no episodes of apnea or cardiorespiratory complications . Ninety-six (92 per cent) of the initial 104 reductions were successf ul, Only four patients subsequently needed general anesthesia for a re peat closed reduction. The physician's satisfaction with the method of sedation was good or excellent for 103 (94 per cent) of the 110 proce dures. Eighty-one (93 per cent) of eighty-seven patients who were able to respond had no memory of the reduction. A telephone survey conduct ed after the procedure revealed that eighty-four (98 per cent) of eigh ty-six parents who responded were satisfied with the method of sedatio n. Intravenous sedation with a narcotic and a benzodiazepine proved to be a safe and effective method of anesthesia for the closed reduction of fractures in children in our series. Careful monitoring of the pat ient after sedation is imperative.