We use two different drugs for pediatric sedation in the ED.
Pentobarbital is our drug of choice for relatively stable children
undergoing painless diagnostic studies such as CT or MRI. Our
protocol is the well published CHOP Radiology Protocol:
Initial dose 2.5 mg/kg IV
Wait 2 minutes if child still awake
Second dose 1.25 mg/kg IV
Wait 3 minutes if child still awake
Third dose 1.25 mg/kg IV
Total dose 5 mg/kg.
We have had 100% success with this protocol.
For children who are unstable or those we need tighter control over
their sedation we use a continous infusion of propofol. Our usual
approach is to load the child with a 0.25-0.5 mg/kg bolus (Higher dose
if the child is intubated, slow push on the lower dose if the child
is not intubated). The bolus is immediately followed by a continuous
infusion of 0.5-3.0 mg/kg/hr. (Higher dose if intubated, lower dose
if not intubated). If the infusion needs to be titrated up, then a
repeat bolus should be administered as the dose is titrated. We have
used higher doses on occassion without a problem.
We have experienced no problems with either of these techniques.
Our Lady of Lourdes Medical Center
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