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Combination Fentanyl and Diazepam for Pediatric Conscious Sedation
Author(s) -
Pohlgeers Anthony P.,
Friedland Leonard R.,
KeeganJones Lisa
Publication year - 1995
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.1995.tb03101.x
Subject(s) - medicine , fentanyl , anesthesia , sedation , diazepam , respiratory rate , pulse oximetry , heart rate , vomiting , orthopedic surgery , blood pressure , emergency department , surgery , psychiatry
Objectives: To evaluate the safety and to describe the use of combination IV diazepam and fentanyl in the pediatric emergency department (PED) as outpatient conscious sedation (CS) for orthopedic procedures. Methods: A retrospective chart review of a standardized protocol for CS administered to 133 consecutive patients requiring CS for outpatient orthopedic procedures. The patients were continuously monitored for heart rate, respiratory rate, and arterial O 2 saturation (SaO 2 ) by pulse oximetry. The study was conducted at a large urban PED and regional referral center. Results: A total of 133 children (mean age 8.5 years) received 138 orthopedic procedures. Mean (± SD) total diazepam dose was 0.12 ± 0.05 mg/kg; mean total fentanyl dose was 3.18 ± 1.04 μg/kg. Mean time intervals were 4.6 minutes from initial drug administration to start of procedure, 15.5 minutes to end of procedure, and 56 minutes to meeting criteria for release home. Complications included Sao 2 < 90% for 15 patients (11%, 95% CI 6.4–17.4%), vomiting for one (0.74s. 95% CI 0.1–4.2%). and severe pruritus for one (0.7%, 95% CI 0.1–4.2%). An episode of Sao 2 < 90% was associated with a higher initial mean fentanyl dose (2.60 vs 1.95 μg/kg; p = 0.0005). but was not associated with a higher initial mean diazepam dose (p = 0.28). Parented opioid use for pain management prior to CS was not associated with an increased risk for Sac), < 90% (p = 0.42). Heart rate, respiratory rate. and blood pressure were stable during the observational period. No patient required naloxone, flumazenil. artificial airway control. or admission to the hospital. Conclusions: At the doses given in the study. the use of combination diazepam and fentanyl for outpatient CS of PED patients during orthopedic procedures was not associated with serious complications. A higher initial fentanyl dose was associated with episodes of SaO 2 < 91%. Therefore, an initial dose of ≤2.0 μg/kg fentanyl titrated to effect is recommended.