Latrogenic cardiopulmonary arrest during pediatric sedation with meperidine, promethazine, and chlorpromazine

The pediatric sedative combination of meperidine, promethazine, and chlorpr omazine (MPC) has been widely used for more than 40 years. Despite its rela tively poor efficacy and questionable safety profile, many emergency depart ments (EDs) continue to stock specially formulated mixtures of these three agents. We report a case of iatrogenic cardiac arrest in a 2-month-old infa nt in whom a consulting resident administered too much MPC (10 times the ex pected dose) by the wrong route (intravenous instead of intramuscular). The child was successfully resuscitated with no apparent neurologic deficit. S ubsequently, we have removed MPC entirely from our ED and instituted a poli cy restricting ED procedural sedation privileges to emergency physicians. W e urge other EDs to do likewise.