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Procedural sedation programme minimising adverse events: a 3-year experience from a tertiary paediatric emergency department
  1. Gokul Erumbala1,
  2. Sabu Anzar2,
  3. Samir Deiratany3,
  4. Barbara Blackie2,4,
  5. Colin Powell2,5,
  6. Khalid Al Ansari2,4,6
  1. 1 Department of Emergency Medicine, Al Jalila Children's Specialty Hospital, Dubai, UAE
  2. 2 Emergency Medicine Department, Sidra Medicine, Doha, Qatar
  3. 3 Royal Free London NHS Foundation Trust, London, UK
  4. 4 Medical College, Weill Cornell Medcial College, Doha, Qatar
  5. 5 Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
  6. 6 Qatar University, Education City, Doha, Qatar
  1. Correspondence to Professor Khalid Al Ansari, Emergency Medicine Department, Sidra Medicine, Doha, Qatar; kalansari{at}


Introduction A well-developed procedural sedation programme in the paediatric emergency department can minimise adverse events. We examined how adherence to current best evidence ensures safe delivery of paediatric sedation in a newly established tertiary paediatric hospital.

Methods Our sedation service uses a robust provider training and privileging system, standardised policy and procedures and rigorous data collection all within an evidence-based clinical governance process. We examined sedation data from the first 3 years of operation.

Results From July 2018 to May 2022, ketamine was used in 3388 of the 3405 sedations. The mean age of sedated children was 5.5 years (range 6 months to 17.8 years) and common indications were closed reduction of fractures and laceration repairs. A total of 148 (4.37%, 95% CI 3.68% to 5.06%) adverse events were documented, including 88 (2.59%, 95% CI 2.06% to 3.13%) cases of vomiting, 50 (1.48%, 95% CI 1.07% to 1.88%) cases related to airway and breathing with 40 (1.18%, 95% CI 0.82% to 1.54%) cases of oxygen desaturation, 6 (0.18%, 95% CI 0.04% to 0.32%) cases of laryngospasm, 4 (0.12%, 95% CI 0% to 0.23%) cases of apnoea.

Conclusion This study presents a large single-centre dataset on the use of intravenous ketamine in paediatric procedural sedation. Adhering to international standards and benchmarks for provider skills and training, drug administration and monitoring facilities, with a strict clinical governance process, optimizes patient safety.

  • analgesia
  • emergency care
  • paediatric emergency medicine
  • pain

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors GE, SD, SA, BB, CP and KAA were all involved with the inception of this paper. All authors were involved with the planning and conduction the data collection. KAA, SD, BB, GE and SA developed and delivered the procedural sedation programme. GE, SD, SA and BB wrote the first draft of the paper and then redrafting and further analysis and critical review of data and manuscript was done by BB, CP and KAA. KAA is guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.