Drug Safety

, Volume 14, Issue 3, pp 146–157 | Cite as

Comparative Review of the Adverse Effects of Sedatives Used in Children Undergoing Outpatient Procedures

  • James D’Agostino
  • Thomas E. Terndrup
Review Articles Drug Experience


Children often fear medical procedures and interventions. Sedative agents enhance the care of these children who undergo outpatient procedures by decreasing anxiety, increasing cooperativity, and providing amnesia. Although higher dosages and intravenous administration of sedatives often produce improved sedation, adverse effects and complications are more frequent. The goals of therapeutic efficacy and safety must be balanced in all patients.

The presence or anticipation of anxiety and pain helps in deciding whether to use a sedative alone, or a regimen also providing analgesia. The patient’s clinical cardiorespiratory or neurological status, other relative contraindications, the duration of the intended procedure, and the presence or absence of an intravenous line will help in choosing specific drugs.

Drug complications are a common cause of adverse events in patients. The combination of a sedative and analgesic, especially a benzodiazepine and an opioid given intravenously, is associated with a higher risk of serious complications. The practitioner responsible for the administration of a sedative to a child must be competent in its use and have the ability to detect and manage complications.

Patients who are deeply sedated should be continuously monitored and observed by an individual dedicated to this task. Vital signs and oxygen saturation should be documented at frequent intervals and the patient should be appropriately monitored until discharge criteria have been met. The risk of serious complications with these agents may be reduced with vigorous monitoring and a judicious choice of dosage.


Morphine Adis International Limited Midazolam Nitrous Oxide Meperidine 
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  1. 1.
    Graff KJ, Kennedy RM, Jaffe DM. Conscious sedation for orthopedic injuries in children [abstract]. Am J Dis Child 1993; 147: 426Google Scholar
  2. 2.
    Schechter NL. The undertreatment of pain in children: an overview. Pediatr Clin North Am 1989; 36: 781–94PubMedGoogle Scholar
  3. 3.
    Schechter NL, Bernstein BA, Beck A, et al. Individual differences in children’s response to pain: role of temperament and parental characteristics. Pediatrics 1991; 87: 171–7PubMedGoogle Scholar
  4. 4.
    Kuttner L. Management of young children’s acute pain and anxiety during invasive medical procedures. Pediatrician 1989; 16: 39–44PubMedGoogle Scholar
  5. 5.
    Terndrup TE. Pain control, analgesia, and sedation. In: Barkin RM, editor. Pediatric emergency medicine: concepts and clinical practice. 2nd ed. St. Louis: Mosby Year Book. In pressGoogle Scholar
  6. 6.
    Arts SE, Abu-Saad HH, Champion GD, et al. Age-related response to lidocaine-prilocaine (EMLA) emulsion and effect of music distraction on the pain of intravenous cannulation. Pediatrics 1994; 93: 797–801PubMedGoogle Scholar
  7. 7.
    Smith DE, Wesson DR. The benzodiazepines: current standards for medical practice, Norwell, (MA): MTP Press Limited, 1985Google Scholar
  8. 8.
    American Academy of Pediatrics, Committee on Drugs. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures. Pediatrics 1992; 89: 1110–5Google Scholar
  9. 9.
    Green SM, Nakamura R, Johnson NE. Ketamine sedation for pediatric procedures. I. A prospective series. Ann Emerg Med 1990; 19: 1024–32PubMedGoogle Scholar
  10. 10.
    Dailey RH, Stone R, Repert W. Ketamine dissociative anesthesia-emergency department use in children. JACEP 1979; 8(2): 57–8PubMedGoogle Scholar
  11. 11.
    Caro DB. Trial of ketamine in an accident and emergency department. Anesthesia 1974; 29: 227–9Google Scholar
  12. 12.
    Tobin HA. Low-dose ketamine and diazepam. Use as an adjunct to local anesthesia in an office operating room. Arch Otolaryngol 1982; 108: 439–40PubMedGoogle Scholar
  13. 13.
    Hannallah RS, Patel RI. Low-dose intramuscular ketamine for anesthesia pre-induction in young children undergoing brief outpatient procedures. Anesthesiology 1989; 70: 598–600PubMedGoogle Scholar
  14. 14.
    Loudon A, Reddy VG. Nasal midazolam and ketamine for paediatric sedation during computerised tomography. Acta Anaesthesiol Scand 1994; 38: 259–61Google Scholar
  15. 15.
    Qureshi FA, Mellis PT, McFadden MA. Efficacy of oral ketamine for providing sedation and analgesia to children requiring laceration repair. Pediatr Emerg Care 1995; 11(2): 93–7PubMedGoogle Scholar
  16. 16.
    Stewart KG, Rowbottom SJ, Aitken AW, et al. Oral ketamine premedication for paediatric cardiac surgery — a comparison with intramuscular morphine (both after oral Trimeprazine). Anaesth Intens Care 1990; 18(1): 11–4Google Scholar
  17. 17.
    Weksler N, Ovadia L, Muati G, et al. Nasal ketamine for paediatric premedication. Can J Anaesth 1993; 40(2): 119–21PubMedGoogle Scholar
  18. 18.
    Gutstein HB, Johnson KL, Heard MB, et al. Oral ketamine preanesthetic medication in children. Anesthesiology 1992; 76: 28–33PubMedGoogle Scholar
  19. 19.
    Bates BA, Schutzman SA, Fleisher GR. A comparison of intranasal sufentanil and midazolam to intramuscular meperidine, promethazine, and chlorpromazine for conscious sedation in children. Ann Emerg Med 1994; 24: 646–51PubMedGoogle Scholar
  20. 20.
    Terndrup TE, Cantor RM, Madden CM. Intramuscular meperidine, promethazine, and chlorpromazine: analysis of use and complications in 487 pediatric emergency department patients. Ann Emerg Med 1989; 18: 528–33PubMedGoogle Scholar
  21. 21.
    Smith C, Rowe RD, Vlad P. Sedation of children for cardiac catheterization with an ataractic mixture. Can Anaesth Soc J 1958; 5: 35–40PubMedGoogle Scholar
  22. 22.
    Myers DR, Shoaf HK. The intramuscular use of a combination of meperidine, promethazine and chlorpromazine for sedation of the child dental patient. J Dent Child 1977; 44: 453–6Google Scholar
  23. 23.
    O’Brien JF, Falk JL, Carey BE, et al. Rectal thiopental compared with intramuscular meperidine, promethazine, and chlorpromazine for pediatric sedation. Ann Emerg Med 1991; 20: 644–7PubMedGoogle Scholar
  24. 24.
    Terndrup TE, Dire DJ, Madden CM, et al. Comparison of intramuscular meperidine and promethazine with and without chlorpromazine: a randomized, prospective, double-blind trial. Ann Emerg Med 1993; 22: 206–11PubMedGoogle Scholar
  25. 25.
    Terndrup TE, Dire DJ, Madden CM, et al. A prospective analysis of intramuscular meperidine, promethazine, and chlorpromazine in pediatric emergency department patients. Ann Emerg Med 1991; 20: 31–5PubMedGoogle Scholar
  26. 26.
    Burckart GJ, White III TJ, Siegle RL, et al. Rectal thiopental versus an intramuscular cocktail for sedating children before computerized tomography. Am J Hosp Pharm 1980; 37: 222–4PubMedGoogle Scholar
  27. 27.
    Anderson RE, Osborn AG. Efficacy of simple sedation for pediatric computed tomography. Radiology 1977; 124: 739–40PubMedGoogle Scholar
  28. 28.
    Riekman G, Ross AS. A sedation technique for the younger child. J Can Dent Assoc 1981; 12: 789–91Google Scholar
  29. 29.
    Ahn NC, Andersen GW, Thomsen A, et al. Preanaesthetic medication with rectal diazepan in children. Acta Anaesth Scand 1981; 25: 158–60PubMedGoogle Scholar
  30. 30.
    Graham DY, Klish Wj, Ferry GD, et al. Value of fiberoptic gastrointestinal endoscopy in infants and children. South Med J 1978; 71(5): 558–60PubMedGoogle Scholar
  31. 31.
    Figueroa-Colon R, Grunow JE. Randomized study of premedication for esophagogastroduodenoscopy in children and asolescents. J Pediatr Gastroenterol Nutr 1988; 7: 359–66PubMedGoogle Scholar
  32. 32.
    Buchmann G. Premedication in children. Acta Anaesth Scand 1965; 9: 139–44PubMedGoogle Scholar
  33. 33.
    Amey BD, Ballinger JA, Harrison EE, et al. Prehospital administration of nitrous oxide for control of pain. Ann Emerg Med 1981; 10(5): 247–51PubMedGoogle Scholar
  34. 34.
    Henderson JM, Spence DG, Komocar LM, et al. Administration of nitrous oxide to pediatric patients provides analgesia for venous cannulation. Anesthesiology 1990; 72(2): 269–71PubMedGoogle Scholar
  35. 35.
    Griffin GC, Campbell VD, Jones R. Nitrous oxide-oxygen sedation for minor surgery. Experience in a pediatric setting. JAMA 1981; 245(23): 2411–3PubMedGoogle Scholar
  36. 36.
    Garnis AS, Knapp JF, Glenski JA, et al. Nitrous oxide analgesia in a pediatric emergency department. Ann Emerg Med 1989; 18(2): 177–81Google Scholar
  37. 37.
    Thal ER, Montgomery SJ, Atkins JM, et al. Self-administered analgesia with nitrous oxide. Adjunctive aid for emergency medical care systems. JAMA 1979; 242(22): 2418–9PubMedGoogle Scholar
  38. 38.
    Nieto JM, Rosen P. Nitrous oxide at higher elevations. Ann Emerg Med 1980; 9(12): 610–2PubMedGoogle Scholar
  39. 39.
    Weinstein P, Domoto PK, Holleman E. The use of nitrous oxide in the treatment of children: results of a controlled study. JADA 1986; 112: 325–31PubMedGoogle Scholar
  40. 40.
    Fukuta O, Braham RL, Yanase H, et al. The sedative effect of intranasal midazolam administration in the dental treatment of patients with mental disabilities. J Clin Pediatr Dent 1993; 17(4): 231–7PubMedGoogle Scholar
  41. 41.
    Payne CG, Edbrooke DL, Davies GK. Minor procedures in the accident and emergency department: can Entonox help? Arch Emerg Med 1991; 8(1): 24–32PubMedGoogle Scholar
  42. 42.
    Sandler ES, Weyman C, Conner K, et al. Midazolam versus fentanyl as premedication for painful procedures in children with cancer. Pediatrics 1992; 89: 631–4PubMedGoogle Scholar
  43. 43.
    Billmire DA, Neale HW, Gregory RO. Use of IV fentanyl in the outpatient treatment of pediatric facial trauma. J Trauma 1985; 25: 1079–80PubMedGoogle Scholar
  44. 44.
    Schutzman SA, Burg J, Liebelt E. Oral transmucosal fentanyl citrate for premedication of children undergoing laceration repair. Ann Emerg Med 1994; 24: 1059–64PubMedGoogle Scholar
  45. 45.
    Conard PL, Rosenblum M, Weisman SJ, et al. Safety and efficacy of oral transmucosal fentanyl citrate (OTFC) for procedures in children [abstract]. Anesthesiology 1991; 75 Suppl.: A954Google Scholar
  46. 46.
    Schechter NL, Weisman SJ, Rosenblum M, et al. Sedation for painful procedures in children with cancer using the fentanyl lollipop: a preliminary report. Adv Pain Res Ther 1990; 15: 209–14Google Scholar
  47. 47.
    Pohlgeers AP, Friedland LR, Keegan-Jones L. Combination fentanyl and diazepam for pediatric conscious sedation. Acad Emerg Med 1995; 2: 879–83PubMedGoogle Scholar
  48. 48.
    Maunuksela EL, Rajantie J, Siimes MA. Flunitrazepam-fentanyl-induced sedation and analgesia for bone marrow aspiration and needle biopsy in children. Acta Anaesthesiol Scand 1986; 30: 409–11PubMedGoogle Scholar
  49. 49.
    Diament MJ, Stanley P. The use of midazolam for sedation of infants and children. Am J Roentgenol 1988; 150: 377–8Google Scholar
  50. 50.
    Fung KP, Math MV, Ho CO, et al. Midazolam as a sedative in esophageal manometry: a study of the effect on esophageal motility. J Pediatr Gastroenterol Nutr 1992; 15: 85–8PubMedGoogle Scholar
  51. 51.
    Taylor MB, Vine PR, Hatch DJ. Intramuscular midazolam premedication in small children. Anaesthesia 1986; 41: 21–6PubMedGoogle Scholar
  52. 52.
    Hennes HM, Wagner V, Bonadio WA, et al. The effect of oral midazolam on anxiety of preschool children during laceration repair. Ann Emerg Med 1990; 19: 1006–9PubMedGoogle Scholar
  53. 53.
    Theroux MC, West DW, Coddry DH, et al. Efficacy of intranasal midazolam in facilitating suturing of lacerations in preschool children in the emergency department. Pediatric 1993; 91: 624–7Google Scholar
  54. 54.
    Karl HW, Rosenberger JL, Larach MG, et al. Transmucosal administration of midazolam for premedication of pediatric patients. Anesthesiology 1993; 78: 885–91PubMedGoogle Scholar
  55. 55.
    Spear RM, Yaster M, Berkowitz IV, et al. Preinduction of anesthesia in children with rectally administered midazolam. Anesthesiology 1991; 74: 670–4PubMedGoogle Scholar
  56. 56.
    Payne KA, Coetzee AR, Mattheyse FJ, et al. Oral midazolam in paediatric premedication. S Afr Med J 1991; 79: 372–5PubMedGoogle Scholar
  57. 57.
    Yealy DM, Ellis JH, Hobbs GD, et al. Intranasal midazolam as a sedative for children during laceration repair. Am J Emerg Med 1992; 10: 584–7PubMedGoogle Scholar
  58. 58.
    Latson LA, Cheatham JPO, Gumbiner CH, et al. Midazolam nose drops for outpatient echocardiography sedation in infants. Am Heart J 1991; 121: 209–10PubMedGoogle Scholar
  59. 59.
    Walbergh EJ, Wills RJ, Eckhert J. Plasma concentrations of miadazolam in children following intranasal administration. Anesthesiology 1991; 74: 233–5PubMedGoogle Scholar
  60. 60.
    Saint-Maurice C, Meistelman C, Rey E, et al. The pharmacokinetics of rectal midazolam for premedication in children. Anesthesiology 1986; 65: 536–8PubMedGoogle Scholar
  61. 61.
    Connors KM, Terndrup TE. Nasal versus oral midazolam for sedation of anxious children undergoing laceration repair. Ann Emerg Med 1994; 24: 1074–9PubMedGoogle Scholar
  62. 62.
    Sievers TD, Yee JD, Foley ME, et al. Midazolam for conscious sedation during pediatric oncology procedures: safety and recovery parameters. Pediatrics 1991; 88: 1172–9PubMedGoogle Scholar
  63. 63.
    Audenaert SM, Lock RL, Johnson GL, et al. Cardiovascular effects of rectal methohexital in children. J Clin Anesth 1992; 4: 116–9PubMedGoogle Scholar
  64. 64.
    Schwanda AE, Freyer DR, Sanfilippo DJ, et al. Brief unconscious sedation for painful pediatric oncology procedures. Intravenous methohexital with appropriate monitoring is safe and effective. Am J Pediatr Hematol Oncol 1993; 15: 370–6PubMedGoogle Scholar
  65. 65.
    Manuli MA, Davies L. Rectal methohexital for sedation of children during imaging procedures. Am J Roentgenol 1993; 160: 577–80Google Scholar
  66. 66.
    Liu LMP, Goudsouzian NG, Liu PH. Rectal methohexital premedication in children, a dose-comparison study. Anesthesiology 1980; 53: 343–5PubMedGoogle Scholar
  67. 67.
    Laishley RS, O’Callaghan AC, Lerman J. Effects of dose and concentration of rectal methohexitone for induction of anaesthesia in children. Can Anaesth Soc J 1986; 33: 427–32PubMedGoogle Scholar
  68. 68.
    Bloomfield EL, Masaryk TJ, Caplin A, et al. Intravenous sedation for MR imaging of the brain and spine in children: pentobarbital versus propofol. Radiology 1993; 186: 93–7PubMedGoogle Scholar
  69. 69.
    Strain JD, Harvey LA, Foley LC, et al. Intravenously administered pentobarbital sodium for sedation in pediatric CT1. Radiology 1986; 161: 105–8PubMedGoogle Scholar
  70. 70.
    Slovis TL, Parks C, Reneau D, et al. Pediatric sedation: shortterm effects. Pediatr Radiol 1993; 23: 345–8PubMedGoogle Scholar
  71. 71.
    Strain JD, Campbell JB, Harvey LA, et al. IV nembutal: safe sedation for children undergoing CT. Am J Roentgenol 1988; 151: 975–9Google Scholar
  72. 72.
    Pereira JK, Burrows PE, Richards HM, et al. Comparison of sedation regimens for pediatric outpatient CT. Pediatr Radiol 1993; 23: 341–4PubMedGoogle Scholar
  73. 73.
    Lebovic S, Reich DL, Steinberg G, et al. Comparison of propofol versus ketamine for anesthesia in pediatric patients undergoing cardiac catheterization. Anesth Analg 1992; 74: 490–4PubMedGoogle Scholar
  74. 74.
    Kain ZN, Gaal DJ, Kain TS, et al. A first-pass cost analysis of propofol versus barbiturates for children undergoing magnetic resonance imaging. 1994; 79: 1102–5Google Scholar
  75. 75.
    Houpt MI, Koenigsberg SR, Weiss NJ, et al. Comparison of chloral hydrate with and without promethazine in the sedation of young children. Pediatr Dent 1985; 7: 41–6PubMedGoogle Scholar
  76. 76.
    Hubbard AM, Markowitz RI, Kimmel B, et al. Sedation for pediatric patients undergoing CT and MRI. J Comput Assist Tomogr 1992; 16(1): 3–6PubMedGoogle Scholar
  77. 77.
    Greenburg SB, Faerber EN, Aspinall CL. High dose chloral hydrate sedation for children undergoing CT. J Comput Assist Tomogr 1991; 15(3): 467–9Google Scholar
  78. 78.
    Lipshitz M, Marino BL, Sanders ST. Chloral hydrate side effects in young children: causes and management. Heart Lung 1993; 22(5): 408–14PubMedGoogle Scholar
  79. 79.
    Ronchera CL, Marti-Bonmati L, Poyatos C, et al. Administration of oral chloral hydrate to paediatric patients undergoing magnetic resonance imaging. Pharm Weekbl Sci 1992; 14(6): 349–52PubMedGoogle Scholar
  80. 80.
    Rumm PD, Takao RT, Fox DJ, et al. Efficacy of sedation of children with chloral hydrate. South Med J 1990; 83(9): 1040–2PubMedGoogle Scholar
  81. 81.
    Binder LS, Leake LA. Chloral hydrate for emergent pediatric procedural sedation: a new look at an old drug. Am J Emerg Med 1991; 9: 530–4PubMedGoogle Scholar
  82. 82.
    Poorman TL, Farrington FH, Mourino AP. Comparison of a chloral hydrate/hydroxyzine combination with and without meperidine in the sedation of pediatric dental patients. Pediatr Dent 1990; 12(5): 288–91PubMedGoogle Scholar
  83. 83.
    Cornejo G, Araneda LB, Gallardo F. Use of lorazepam as premedication for apprehensive children. J Pedod 1985; 9: 136–41PubMedGoogle Scholar
  84. 84.
    Van de Velde A, Schneider I, Camu F. A double-blind comparison of the efficacy of lorazepam FDDF versus placebo for anesthesia premedication in children. Acta Anaesthesiol Belg 1987; 38(3): 207–12PubMedGoogle Scholar
  85. 85.
    Ponnudurai R, Hurdley J. Bromazepam as oral premedication: a comparison with lorazepam. Anaesthesia 1986; 41(5): 541–3PubMedGoogle Scholar
  86. 86.
    Peters CG, Brunton JT. Comparative study of lorazepam and trimeprazine for oral premedication in paediatric anaesthesia. Br J Anaesth 1982; 54: 623–8PubMedGoogle Scholar
  87. 87.
    Lee DS, Wong HA, Knoppert DC. Myoclonus associated with lorazepam therapy in very-low-birth-weight infants. Biol Neonate 1994; 66(6): 311–5PubMedGoogle Scholar
  88. 88.
    Reiter PD, Stiles AD. Lorazepam toxicity in a premature infant. Ann Pharmacother 1993; 27(6): 727–9PubMedGoogle Scholar
  89. 89.
    Chiulli DA, Terndrup TE, Kanter RK. The Influence of diazepam or lorazepam on the frequency of endotracheal intubation in childhood status epilepticus. J Emerg Med 1991; 9: 13–7PubMedGoogle Scholar
  90. 90.
    Woolard DJ, Terndrup TE. Sedative-analgesic agent administration in children: analysis of use and complications in the emergency department. J Emerg Med 1994; 12: 453–61PubMedGoogle Scholar
  91. 91.
    Seigier RS. The Administration of rectal diazepam for acute management of seizures. J Emerg Med 1990; 8: 155–9Google Scholar
  92. 92.
    Cote CJ. Sedation for the pediatric patient: a review. Pediatr Clin North Am 1994; 41: 31–58PubMedGoogle Scholar
  93. 93.
    Buhrer M, Maitre PO, Crevoisier C, et al. Electroencephalographic effects of benzodiazepines. II. Pharmacodynamic modeling of the electroencephalographic effects of midazolam and diazepam. Clin Pharmacol Ther 1990; 48: 555–67PubMedGoogle Scholar
  94. 94.
    Shane SA, Fuchs SM, Khine H. Efficacy of rectal midazolam for the sedation of preschool children undergoing laceration repair. Ann Emerg Med 1994; 24(6): 1065–73PubMedGoogle Scholar
  95. 95.
    Rockoff MA, Goudsouzian NG. Seizures induced by Methohexital. Anesthesiology 1981; 54: 333–5PubMedGoogle Scholar
  96. 96.
    Bjorkman S, Gabrielsson J, Quaynor H, et al. Pharmacokinetics of i.v. and rectal methohexitone in children. Br J Anaesth 1987; 59(12): 1541–7PubMedGoogle Scholar
  97. 97.
    Forbes RB, Manago NK, Dull DL, et al. Pharmacokinetics of intramuscular methohexital in children [abstract]. Anesth Analg 1990; 70: S1–S450Google Scholar
  98. 98.
    McGee JL, Alexander MR. Phenothiazine analgesia: fact or fantasy? Am J Hosp Pharm 1979; 36: 633–40PubMedGoogle Scholar
  99. 99.
    Brown FE, Nierenberg DW, Nordgren RE, et al. Neuroleptic malignant syndrome: occurrence in a child after reconstructive surgery. Plast Reconstr Surg 1991; 87(5): 961–4PubMedGoogle Scholar
  100. 100.
    Keeter S, Benator RM, Weinberg SM, et al. Sedation in pediatric CT: national survey of current practice. Radiology 1990; 175: 745–52PubMedGoogle Scholar
  101. 101.
    Lambert GH, Muraskas J, Anderson CL, et al. Direct hyperbilirubinemia associated with chloral hydrate administration in the newborn. Pediatrics 1990; 86: 277–81PubMedGoogle Scholar
  102. 102.
    Mayers DJ, Hindmarsh KW, Sankaran K, et al. Chloral hydrate disposition following single-dose administration to critically ill neonates and children. Dev Pharmacol Ther 1991; 16: 71–7PubMedGoogle Scholar
  103. 103.
    Committee on Drugs and Committee on Environmental Health, American Academy of Pediatrics. Use of chloral hydrate for sedation in children. Pediatrics 1993; 92: 471–3Google Scholar
  104. 104.
    Mallol J, Sly PD. Effects of chloral hydrate on arterial oxygen saturation in wheezy infants. Pediatr Pulmonol 1988; 5: 96–9PubMedGoogle Scholar
  105. 105.
    Biban P, Baraldi E, Pettenazzo A, et al. Adverse effect of chloral hydrate in two young children with obstructive sleep apnea. Pediatrics 1993; 92: 461–3PubMedGoogle Scholar
  106. 106.
    Yaster M, Deshpande JK, Maxwell LG. The pharmacologie management of pain in children. Compr Ther 1989; 15(10): 14–26PubMedGoogle Scholar
  107. 107.
    Yaster M, Deshpande JK. Management of pediatric pain with opioid analgesics. J Pediatr 1988; 113: 421–9PubMedGoogle Scholar
  108. 108.
    Lynn AM, Slattery JT. Morphine-pharmacokinetics in early infancy. Anesthesiology 1987; 66: 136–9PubMedGoogle Scholar
  109. 109.
    Tholl DA, Wager MS, Sajous CH, et al. Morphine use and adverse effects in a neonatal intensive care unit. Am J Hosp Pharm 1994; 51(22): 2801–3PubMedGoogle Scholar
  110. 110.
    Quinn MW, Wild J, Dean HG, et al. Randomised double-blind controlled trial of effect of morphine on catecholamine concentrations in ventilated pre-term babies. Lancet 1993; 342(8867): 324–7PubMedGoogle Scholar
  111. 111.
    Trentadue NC, Bollig A. Physiologic and behavioral responses of children receiving intermittent intravenous morphine following orthopaedic surgery. Orthop Nurs 1993; 12: 41–6PubMedGoogle Scholar
  112. 112.
    Paris PM, Stewart RD. Pain management in emergency medicine. Norwalk, (CT): Appleton & Lange, 1988Google Scholar
  113. 113.
    Goetting MG, Thirman JM. Neurotoxicity of meperidine. Ann Emerg Med 1985; 14: 1007–9PubMedGoogle Scholar
  114. 114.
    Rayburn RL. Ventilatory therapy, anesthesia, and respiratory support. In: Mayer TA. Emergency management of pediatric trauma. Philadelphia: WB Saunders Co., 1985Google Scholar
  115. 115.
    Saravia ME, Currie WR, Campbell RL. Cardiopulmonary parameters during meperidine, promethazine, and chlorpromazine sedation for pediatric dentistry. Anesth Prog 1987; 34: 92–6PubMedGoogle Scholar
  116. 116.
    Nahata MC, Clotz MA, Krogg EA. Adverse effects of meperidine, promethazine, and chlorpromazine for sedation in pediatric patients. Clin Pediatr (Phila) 1985; 24: 558–60Google Scholar
  117. 117.
    Cohen GH, Casta A, Sapire DW, et al. Decorticate posture following ‘cardiac cocktail’: a transient complication of sedation for catheterization. Pediatr Cardiol 1982; 2: 251–3PubMedGoogle Scholar
  118. 118.
    Indelicato PA. Comparison of diflunisal and acetaminophen with codeine in the treatment of mild to moderate pain due to strains and sprains. Clin Ther 1986; 8(3): 269–74PubMedGoogle Scholar
  119. 119.
    Hawk W, Crockett RK, Ochsenschlager DW, et al. Conscious sedation of the pediatric patient for suturing: a survey. Pediatr Emerg Care 1990; 6: 84–8PubMedGoogle Scholar
  120. 120.
    Ros SP. Outpatient pediatric analgesia: a tale of two regimens. Pediatr Emerg Care 1987; 3: 228–30PubMedGoogle Scholar
  121. 121.
    Stambaugh JE, Wainer IW. Drug interaction: meperidine and chlorpromazine, a toxic combination. J Clin Pharmacol 1981; 21: 140–6PubMedGoogle Scholar
  122. 122.
    Cartwright P, Prys-Robert C, Gill K, et al. Ventilatory depression related to plasma fentanyl concentrations during and after anesthesia in humans. Anesth Analg 1983; 62: 966–74PubMedGoogle Scholar
  123. 123.
    Karl HW, Keifer AT, Rosenberger JL, et al. Comparison of the safety and efficacy of intranasal midazolam or sufentanil for preinduction of anesthesia in pediatric patients. Anesthesiology 1992; 76(2): 209–15PubMedGoogle Scholar
  124. 124.
    White PF, Way WL, Trevor AJ. Ketamine: its pharmacology and therapeutic uses. Anesthesiology 1982; 56: 119–36PubMedGoogle Scholar
  125. 125.
    Green SM, Johnson NE. Ketamine sedation for pediatric procedures. II. Review and implications. Ann Emerg Med 1990; 19: 1033–46PubMedGoogle Scholar
  126. 126.
    Flomenbaum N, Gallagher EJ, Eagen K, et al. Self-administered nitrous oxide: an adjunct analgesic. JACEP 1979; 8: 95–7PubMedGoogle Scholar
  127. 127.
    Sams DR, Thornton JB, Wright JT, et al. The assessment of two oral sedation drug regimens in pediatric dental patients. J Dent Child 1992; 59: 306–12Google Scholar
  128. 128.
    Biebuyck JF, Phil D. The nonhypnotic therapeutic applications of propofol. Anesthesiol 1994; 80: 642–56Google Scholar
  129. 129.
    Cauldwell CB, Fisher DM. Sedating pediatric patients: is propofol a panacea? Radiology 1993; 186: 9–10PubMedGoogle Scholar
  130. 130.
    Parke TJ, Stevens JE, Rice AS, et al. Metabolic acidosis and fatal myocardial failure after propofol infusion in children: five case reports. BMJ 1992; 305(6854): 613–6PubMedGoogle Scholar
  131. 131.
    Finley GA, MacManus B, Sampson SE, et al. Delayed seizures following sedation with propofol. Can J Anaesth 1993; 40(9): 863–5PubMedGoogle Scholar
  132. 132.
    Leape LL, Brennan TA, Laird N, et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med 1991; 324(6): 377–84PubMedGoogle Scholar
  133. 133.
    Leape LL, Bates DW, Cullen DJ, et al. Systems analysis of adverse drug events. ADE Prevention Study Group. JAMA 1995; 274(1): 35–43PubMedGoogle Scholar
  134. 134.
    Krippaehne JA, Montgomery MT. Morbidity and mortality from pharmacosedation and general anesthesia in the dental office. J Oral Maxillofac Surg 1992; 50: 691–9PubMedGoogle Scholar

Copyright information

© Adis International Limited 1995

Authors and Affiliations

  • James D’Agostino
    • 1
  • Thomas E. Terndrup
    • 1
  1. 1.Department of Emergency MedicineState University of New York Health Science Center at SyracuseSyracuseUSA

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