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ABSTRACT
The Comparison of Sedative Effects of Ketamine and Etomidate for the Reduction
of Children with Limb Fracture/Joint Dislocation
Introduction: 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
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