The comparison of sedative effects of ketamine and etomidate for the reduction of children with limb fracture/joint dislocation

The Comparison of Sedative Effects of Ketamine and Etomidate for the Reduction of Children with Limb Fracture/Joint DislocationIntroduction: The efficient and safe relief of pain, anxiety and stress of children with limb fractures/joint dislocations is essential for initial evaluation and proper treatment in the emergency department.Aim: The goal of our study was to compare the induction and recovery times, and emergency department stay duration of children needed closed reduction for limb fracture/joint dislocation who were sedated with etomidate or ketamine. We also aimed to evaluate the procedural success and side effects of the agents, the satisfaction levels of patients?, parents? and the physicians?.Materials and Methods: This study was performed as a prospective, randomized and blinded clinical study in 7-18 years old aged 44 healthy children with seperated limb fractures/joint dislocations in Pediatric Emergency Unit of Cukurova University School of Medicine between December 2005 and October 2007. The patients were divided into two groups, one received etomidate+fentanyl while other received ketamine for procedural sedation. The induction and recovery times of the agents, emergency department stay durations and vital signs and Ramsay sedation scores of patients before, during and after sedation procedure were measured. Side effects and satisfaction levels of the patients?, parents? and the physicians? were evaluated by a questionnaire.Results: The mean induction time in minutes in Group 1 was 4,3±1,0 and 2,2±1,6 in Group 2 (p=0,00), where mean recovery time was 15,8±7,7 minutes in Group 1 and 20,7±10,8 minutes in Group 2. The mean of emergency department stay duration was 145,5±63,3 minutes in Group 1 and 196,5±141,6 minutes in Group 2. Frequency of side effects was 37,5% in Group 1 and 25,0% in Group 2. Children sedated with etomidate complained less pain (p=0,042), and patients and parents were more satisfied. (p=0,020 and p=0,019).Conclusions: The induction time with ketamine was shorter than with etomidate but recovery times, emergency department stay durations and side effect frequencies were similar in both groups. Etomidate and ketamine are both safe for procedural sedation of children in the emergency department.Keywords: Children, closed reduction, sedation, etomidate, ketamine