Procedural sedation for pediatric laceration repair

SCOPE OF THE PROBLEM In 2002 over 2.4 million children with lacerations were seen in emergency departments (ED) across the United States. Children have many characteristics that can make proper wound management and laceration repair challenging. Young age and anxiety preclude many children from being able to hold still sufficiently to facilitate proper wound care, even when appropriate analgesia has been administered. This frequently results in the need to control patient motion using procedural sedation. Three large, prospective series describing procedural sedation in children found that procedural sedation for laceration repair represents from 18% to 58% of all sedation provided to children. In a recent survey, adults with traumatic lacerations were asked to report what they felt were the most important priorities regarding their care. The top priorities were return of normal function, avoiding infection, cosmetic outcome, and the least painful repair possible. Procedural sedation is administered to children with lacerations to facilitate wound management and repair, as well as to control pain, coinciding with the top priorities of adult patients receiving laceration repair. Cost and length of stay were ranked less highly in this survey. The fact that patients were less concerned with the cost and length of stay related to their laceration care is important, as both have been found to be increased when sedation is provided to pediatric patients for minor laceration repair. The importance of providing appropriate analgesia and local anesthesia for lacerations cannot be overemphasized, as many of the drugs discussed in this chapter provide sedation without analgesia. In addition, providing proper local anesthesia and analgesia may decrease presedation agitation and facilitate the sedation and wound repair.