Scientific article
Open access

Pediatric procedural sedation and analgesia in the emergency department: surveying the current European practice

ContributorsSahyoun, Cyrilorcid; Cantais, Aymericorcid; Gervaix, Alain; Bressan, Silvia; Löllgen, Ruth; Krauss, Baruch; the Pediatric Emergency Medicine Comfort and Analgesia Research in Europe (PemCARE) group of the Research in European Pediatric Emergency Medicine
Published inEuropean journal of pediatrics, vol. 180, no. 6, p. 1799-1813
Publication date2021-06
First online date2021-01-28

Procedural sedation and analgesia outside the operating theater have become standard care in managing pain and anxiety in children undergoing diagnostic and therapeutic procedures. The objectives of this study are to describe the current pediatric procedural sedation and analgesia practice patterns in European emergency departments, to perform a needs assessment-like analysis, and to identify barriers to implementation. A survey study of European emergency departments treating children was conducted. Through a lead research coordinator identified through the Research in European Pediatric Emergency Medicine (REPEM) network for each of the participating countries, a 30-question questionnaire was sent, targeting senior physicians at each site. Descriptive statistics were performed. One hundred and seventy-one sites participated, treating approximately 5 million children/year and representing 19 countries, with a response rate of 89%. Of the procedural sedation and analgesia medications, midazolam (100%) and ketamine (91%) were available to most children, whereas propofol (67%), nitrous oxide (56%), intranasal fentanyl (47%), and chloral hydrate (42%) were less frequent. Children were sedated by general pediatricians in 82% of cases. Safety and monitoring guidelines were common (74%), but pre-procedural checklists (51%) and capnography (46%) less available. In 37% of the sites, the entire staff performing procedural sedation and analgesia were certified in pediatric advanced life support. Pediatric emergency medicine was a board-certified specialty in 3/19 countries. Physician (73%) and nursing (72%) shortages and lack of physical space (69%) were commonly reported as barriers to procedural sedation and analgesia. Nurse-directed triage protocols were in place in 52% of the sites, mostly for paracetamol (99%) and ibuprofen (91%). Tissue adhesive for laceration repair was available to 91% of children, while topical anesthetics for intravenous catheterization was available to 55%. Access to child life specialists (13%) and hypnosis (12%) was rare.Conclusion: Procedural sedation and analgesia are prevalent in European emergency departments, but some sedation agents and topical anesthetics are not widely available. Guidelines are common but further safety nets, nurse-directed triage analgesia, and nonpharmacologic support to procedural sedation and analgesia are lacking. Barriers to implementation include availability of sedation agents, staff shortage, and lack of space.

  • Ambulatory surgical procedures
  • Emergency medicine
  • Hypnotics and sedatives
  • Non-pharmacological approaches
  • Pediatrics
  • Procedural sedation and analgesia
  • Analgesia
  • Child
  • Conscious Sedation
  • Emergency Service, Hospital
  • Europe
  • Humans
  • Hypnotics and Sedatives
  • Pain / drug therapy
  • Pain / etiology
  • Surveys and Questionnaires
Citation (ISO format)
SAHYOUN, Cyril et al. Pediatric procedural sedation and analgesia in the emergency department: surveying the current European practice. In: European journal of pediatrics, 2021, vol. 180, n° 6, p. 1799–1813. doi: 10.1007/s00431-021-03930-6
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ISSN of the journal0340-6199

Technical informations

Creation11/04/2022 11:36:00 AM
First validation11/04/2022 11:36:00 AM
Update time03/16/2023 10:09:25 AM
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