Paediatric procedural sedation and analgesia in a South African emergency centre: a single-centre, descriptive study
Abstract Background Procedural sedation and analgesia are considered a core competency in emergency medicine as patients present to the emergency centre on an unscheduled basis, often with complex complaints that necessitate emergent management. Previous evidence has consistently shown that procedur...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-05-01
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| Series: | International Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12245-023-00508-x |
| _version_ | 1797823032078630912 |
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| author | Cornelle Dunn Philip Cloete Colleen Saunders Katya Evans |
| author_facet | Cornelle Dunn Philip Cloete Colleen Saunders Katya Evans |
| author_sort | Cornelle Dunn |
| collection | DOAJ |
| description | Abstract Background Procedural sedation and analgesia are considered a core competency in emergency medicine as patients present to the emergency centre on an unscheduled basis, often with complex complaints that necessitate emergent management. Previous evidence has consistently shown that procedural sedation and analgesia in the emergency centre in the paediatric population, even the very young, are safe if appropriate monitoring is performed and appropriate medications are used. The aim of the study was to describe the indications for procedural sedation and analgesia, the fasting status of paediatric patients undergoing procedural sedation and analgesia and the complications observed during procedural sedation and analgesia in the paediatric population at a single emergency centre in Cape Town, South Africa. Methods A retrospective, descriptive study was conducted at Mitchells Plain Hospital, a district-level hospital situated in Mitchells Plain, Cape Town. All paediatric patients younger than 13 years of age who presented to the emergency centre and received procedural sedation and analgesia during the study period (December 2020–April 2021) were included in the study. Data was extracted from a standardised form, and simple descriptive statistics were used. Results A total of 113 patients (69% male) were included: 13 infants (< 1 year of age), 47 young children (1–5 years of age) and 53 older children (5–13 years of age). There was only 1 (0.9%) complication documented, which was vomiting and did not require admission. The majority of patients received ketamine (96.5%). The standardised procedural sedation and analgesia form was completed in 49.1% of cases. Indications included burns debridement (11.5%), suturing (17.7%), fracture reduction (23.9%), lumbar punctures (31.9%) and others (15.0%). The indications for procedural sedation and analgesia varied between the different age groups. The majority of patients in this study did not have their fasting status documented (68.1%), and 18.6% were not appropriately fasted as per American Society of Anaesthesiology guidelines. Despite this, there was an extremely low rate of documented complications of 0.9%. Conclusion The study findings are in accordance with previous international literature reporting low complication rates. Although fasting status was unknown in the majority of patients, there was an extremely low rate of documented complications and no interventions required. Safe, timely procedural sedation and analgesia with minimal pain and unnecessary suffering can become the norm in emergency medicine practice in South Africa. |
| first_indexed | 2024-03-13T10:18:07Z |
| format | Article |
| id | doaj.art-aa94dbe8c4cf436189ebb3fcdfd307c9 |
| institution | Directory Open Access Journal |
| issn | 1865-1380 |
| language | English |
| last_indexed | 2024-03-13T10:18:07Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Emergency Medicine |
| spelling | doaj.art-aa94dbe8c4cf436189ebb3fcdfd307c92023-05-21T11:07:23ZengBMCInternational Journal of Emergency Medicine1865-13802023-05-011611810.1186/s12245-023-00508-xPaediatric procedural sedation and analgesia in a South African emergency centre: a single-centre, descriptive studyCornelle Dunn0Philip Cloete1Colleen Saunders2Katya Evans3Division of Emergency Medicine, Faculty of Health Sciences, University of Cape TownDivision of Emergency Medicine, Faculty of Health Sciences, University of Cape TownDivision of Emergency Medicine, Faculty of Health Sciences, University of Cape TownDivision of Emergency Medicine, Faculty of Health Sciences, University of Cape TownAbstract Background Procedural sedation and analgesia are considered a core competency in emergency medicine as patients present to the emergency centre on an unscheduled basis, often with complex complaints that necessitate emergent management. Previous evidence has consistently shown that procedural sedation and analgesia in the emergency centre in the paediatric population, even the very young, are safe if appropriate monitoring is performed and appropriate medications are used. The aim of the study was to describe the indications for procedural sedation and analgesia, the fasting status of paediatric patients undergoing procedural sedation and analgesia and the complications observed during procedural sedation and analgesia in the paediatric population at a single emergency centre in Cape Town, South Africa. Methods A retrospective, descriptive study was conducted at Mitchells Plain Hospital, a district-level hospital situated in Mitchells Plain, Cape Town. All paediatric patients younger than 13 years of age who presented to the emergency centre and received procedural sedation and analgesia during the study period (December 2020–April 2021) were included in the study. Data was extracted from a standardised form, and simple descriptive statistics were used. Results A total of 113 patients (69% male) were included: 13 infants (< 1 year of age), 47 young children (1–5 years of age) and 53 older children (5–13 years of age). There was only 1 (0.9%) complication documented, which was vomiting and did not require admission. The majority of patients received ketamine (96.5%). The standardised procedural sedation and analgesia form was completed in 49.1% of cases. Indications included burns debridement (11.5%), suturing (17.7%), fracture reduction (23.9%), lumbar punctures (31.9%) and others (15.0%). The indications for procedural sedation and analgesia varied between the different age groups. The majority of patients in this study did not have their fasting status documented (68.1%), and 18.6% were not appropriately fasted as per American Society of Anaesthesiology guidelines. Despite this, there was an extremely low rate of documented complications of 0.9%. Conclusion The study findings are in accordance with previous international literature reporting low complication rates. Although fasting status was unknown in the majority of patients, there was an extremely low rate of documented complications and no interventions required. Safe, timely procedural sedation and analgesia with minimal pain and unnecessary suffering can become the norm in emergency medicine practice in South Africa.https://doi.org/10.1186/s12245-023-00508-xEmergency centreProcedural sedation and analgesiaPaediatricsFasting status |
| spellingShingle | Cornelle Dunn Philip Cloete Colleen Saunders Katya Evans Paediatric procedural sedation and analgesia in a South African emergency centre: a single-centre, descriptive study International Journal of Emergency Medicine Emergency centre Procedural sedation and analgesia Paediatrics Fasting status |
| title | Paediatric procedural sedation and analgesia in a South African emergency centre: a single-centre, descriptive study |
| title_full | Paediatric procedural sedation and analgesia in a South African emergency centre: a single-centre, descriptive study |
| title_fullStr | Paediatric procedural sedation and analgesia in a South African emergency centre: a single-centre, descriptive study |
| title_full_unstemmed | Paediatric procedural sedation and analgesia in a South African emergency centre: a single-centre, descriptive study |
| title_short | Paediatric procedural sedation and analgesia in a South African emergency centre: a single-centre, descriptive study |
| title_sort | paediatric procedural sedation and analgesia in a south african emergency centre a single centre descriptive study |
| topic | Emergency centre Procedural sedation and analgesia Paediatrics Fasting status |
| url | https://doi.org/10.1186/s12245-023-00508-x |
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