Etomidate for pediatric sedation prior to fracture reduction

Objective: While etomidate is reported as a procedural sedative in adults, its use in children has not been extensively reported. The authors describe their experience with etomidate for procedural sedation in children with e xtremity fractures and major joint dislocations. Methods: This was a retros pective descriptive chart review. The setting was a university-based emerge ncy department (ED) that follows national guidelines for procedural sedatio n. Subjects were children less than 18 years old who received etomidate pri or to fracture reduction or major joint dislocations. Standardized data wer e abstracted from the medical records, including patient demographics, diag nosis, weight, types and doses of sedative and analgesic agents used, numbe r of boluses of etomidate, attempts at reduction, complications encountered , vitals signs before, during, and after the reduction, disposition, and th e time from procedure to discharge. Descriptive statistics calculated inclu ded means and proportions with 95% confidence intervals. Results: Fifty-thr ee children received etomidate for fracture reduction. Their mean age was 9 .7; 41.5% were females. Indications for reduction included forearm fracture s (38), ankle fractures (12), upper arm fractures (2), and hip dislocations (1). In most cases (83%) reduction was successful after one attempt only. The mean initial and total doses of etomidate were 0.20 mg/kg (range, 0.1 t o 0.4) and 0.24 mg/kg (range, 0.13 to 0.52), respectively. Thirteen patient s required a second bolus of etomidate or midazolam. Thirty-four patients ( 64%) were discharged from the ED after a mean observation of 94 minutes (ra nge, 35 to 255). There were no major adverse events (95% CI = 0% to 5.1%). One patient reported nausea and one required a fluid bolus for hypotension. One patient receiving multiple sedatives and opioid analgesics was admitte d for observation due to prolonged sedation. No patient required assisted v entilation or intubation. Conclusions: These results suggest that etomidate is a safe and effective agent for procedural sedation in children requirin g fracture and major joint reductions.