@article{Seiler_Staubli_2019, title={Ketamine procedural analgosedation before and after introducing nitrous oxide 70% in a paediatric emergency department}, volume={149}, url={https://smw.ch/index.php/smw/article/view/2589}, DOI={10.4414/smw.2019.20027}, abstractNote={<p><strong>AIMS OF THE STUDY</strong> <p>The spectrum of agents available for procedural analgosedation (PAS) in paediatric emergency departments (EDs) has increased over the last few decades, yet the pharmacological agents most used in our ED are ketamine and nitrous oxide (N<sub>2</sub>O). The aim of this study was to assess which patient characteristics in an ambulatory setting were associated with physicians selecting N<sub>2</sub>O 70% or ketamine as the sedating agent in our paediatric ED, after N<sub>2</sub>O 70% was introduced.</p> <strong>METHODS</strong> <p>Patients aged 0 to 16 years who received PAS in a tertiary children’s hospital ED in 2007 (before N<sub>2</sub>O 70% implementation) and 2016 (after N<sub>2</sub>O implementation) were included in this retrospective, single-centre cohort study. Data were collected by querying the outpatient ED database for N<sub>2</sub>O 70% and ketamine. Obtained data included patient characteristics, procedure type and sedation medication.</p> <strong>RESULTS</strong> <p>1168 patients were included; 59.8% (699) were male. The overall mean age was 6.3 (± 4.0) years; in the ketamine subgroup, 4.6 (± 4.0) years and in the N<sub>2</sub>O subgroup, 7.8 (± 3.4) years. In 2016, N<sub>2</sub>O was chosen in 86.7% of cases involving children aged 4 to 16 years, compared to 28.5% of cases involving children three years and younger. The most apparent shift from ketamine to N<sub>2</sub>O occurred in patients with displaced upper extremity fractures, with an increase of N<sub>2</sub>O 70% from 0% in 2007 to 90.8% in 2016.</p> <strong>CONCLUSIONS</strong> <p>The use of ketamine PAS shifted to N<sub>2</sub>O PAS, especially in children older than three years and for the reduction of displaced upper extremity fractures.</p></p>}, number={0910}, journal={Swiss Medical Weekly}, author={Seiler, Michelle and Staubli, Georg}, year={2019}, month={Mar.}, pages={w20027} }