A comprehensive systematic review and meta-analysis of the safety of procedural sedation in pediatric emergency rooms

Abstract

In pediatric emergency departments (PEDs), procedural sedation is frequently used to reduce pain and anxiety to support therapeutic and diagnostic procedures. The purpose of this meta-analysis was to evaluate the safety profiles of common sedatives in the setting of PEDs. An extensive search of four databases was conducted to identify studies reporting adverse effects associated with procedural sedation in pediatric emergency settings. Studies that reported on sedation-related outcomes and involved patients younger than 18 were considered eligible. A proportionate meta-analysis was conducted employing random-effects model. Sixty-six trials with a total of 20,043 pediatric patients were included. Propofol had the highest incidence of apnea (39%) and ketamine had the lowest (14%). The combined incidence of apnea was 19% (95% CI: 15–23%). 36% of patients (95% CI: 31–41%) had hypoxia; the highest rates were seen with etomidate (83%) and dexmedetomidine (56%), while the lowest rates were seen with nitrous oxide (9%), and chloral hydrate (11%). 40% of instances had agitation, which was most common with regimens based on midazolam. Among the secondary adverse events were nausea (44%) and vomiting (55%). Higher rates of apnea and hypoxia were noted in children above the age of 3. While nitrous oxide and chloral hydrate showed better safety profiles, propofol was linked to the highest risk of respiratory complications. These results highlight the significance of further research to improve sedation protocols and support the necessity of agent-specific, patient-centered sedation techniques in pediatric emergency care.