Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science


Pediatric Emergency Medicine


Dr. June Sullivan, DMSc, PA-C


It is not uncommon for pediatric emergency room patients to suffer extreme pain and anxiety with laceration repairs, fracture reductions, or complicated procedures requiring immobilization. To reduce pain and anxiety, procedural sedation and analgesia are administered. The most common sedative used in pediatric emergency departments is ketamine, which is often the best option for the sedation of pediatric patients. However, several prominent side effects are associated with procedural sedation, including hypoxia, laryngospasm, emesis, and apneas. Sedation can lead to emesis, which is a common side effect.

There is controversy concerning premedicating with antiemetics, one of the most common treatments for emesis, in conjunction with pediatric ketamine sedation. However, ondansetron has been used to reduce emesis associated with viral illness, anesthesia, and chemotherapy. There have been favorable outcomes associated with pre-medicating children with ondansetron to prevent post-procedural emesis after ketamine sedation. Studies have shown that the administration of intravenous ondansetron before ketamine sedation has reduced post-procedural emesis.

The majority of pediatric patients can tolerate painful procedures without experiencing significant discomfort or remembering their discomfort with ketamine sedation. If ondansetron could be used to reduce post-procedural sedation-associated emesis, then this treatment could make all patients' visits safer and faster recovery times. At many institutions, ondansetron is not part of the routine sedation protocol.


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