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<< Managing Pediatric Procedural Pain and Anxiety in the Emergency Department

Critical Appraisal Of The Literature

Over the last 20 years there has been increased interest and research in the reduction of patient pain and anxiety. So much interest that the American Academy of Pediatrics (AAP), American College of Emergency Physicians (ACEP), the American Society of Anesthesiologists (ASA) and the Canadian Association of Emergency Physicians have published guidelines on sedation and analgesia in recent years.1-8 These published recommendations provide practitioners with an expert opinion to help facilitate the safe utilization of procedural sedation and analgesia. However, the level of evidence available for pediatric pain management and procedural sedation is varied and largely consists of class II-III studies. Due to the lack of clinical evidence in children, emergency practitioners are often forced to make clinical judgments based on studies of adults.

Abbreviations Used in this Article
AAP American Academy of Pediatrics
ACEP American College of Emergency Physicians
ALA Adrenaline, Lignocaine (Lidocaine), Amethocaine
ASA American Society of Anesthesiologists
CNS Central Nervous System
EM Emergency medicine
EMLA Eutectic mixture of lidocaine and prilocaine
EMTP Emergency medicine technician-paramedic
ETCO2 end tidal carbon dioxide
F/M Fentanyl/Midazolam
GABA Gamma-aminobutyric acid
ICU Intensive care unit
IM Intramuscular
IQ - Intelligence quotient
IV Intravenous
JCAHO Joint Commission on Accreditation of Healthcare Organizations
K/M Ketamine/Midazolam
LAT Lidocaine, Adrenaline, Tetracaine
LET Lidocaine, Epinephrine, Tetracaine
LP Lumbar puncture
npo nil per os (nothing by mouth)
NSAID Non-steroidal anti-inflammatory drug
RSI Rapid sequence intubation
TAC Tetracaine, Adrenaline, Cocaine
VAS Visual analogue scale