Adverse events during sedation for oro-dental trauma in an Israeli paediatric emergency department.

There is a paucity of data regarding the safety of the practice of sedation for oro-dental trauma in paediatric emergency departments (ED). A previous study reported the safety of intramuscular ketamine administered as a single agent. In the paediatric ED of a tertiary trauma centre in Israel, one of two ketamine-based regimens is used for sedating children with intraoral injuries according to the physician's discretion: a single dose of intramuscular ketamine or a combination of ketamine and propofol (KP) intravenously. The aim of this study was to assess the safety of KP sedation in children undergoing emergency treatment of oro-dental injuries in this paediatric ED. The primary outcome was sedation adverse events that required intervention (SAERI): prolonged oxygen desaturation and apnoea, laryngospasm, hypotension, bradycardia, partial or complete airway obstruction, and pulmonary aspiration. During the 2 years study period, 17 children were sedated with KP, 20 with intramuscular ketamine and 29 with nitrous oxide. Patients who were treated with ketamine-based sedation or with nitrous oxide sedation had a median (interquartile range, IQR) age of 3 (2-4) years and 7 (5-9) years, respectively. No SAERI occurred in patients who were sedated with intramuscular ketamine. One (3.4%) SAERI was reported in a patient who was sedated with N2 O. Six/17 (35%) SAERI occurred in patients who were sedated with KP. These findings suggest that caution should be used when young children with oro-dental injuries are sedated with KP in the ED.