Ketamine Versus Etomidate for Procedural Sedation for Pediatric Orthopedic Reductions

Ketamine Versus Etomidate for Procedural Sedation for Pediatric Orthopedic Reductions

There are multiple retrospective studies detailing the use of etomidate in pediatric procedural sedation but few to no prospective clinical trials. None have compared etomidate to ketamine, currently the most commonly used sedative in the emergency department for pediatric procedural sedation. The investigators propose a randomized, controlled trial comparing etomidate versus ketamine for procedural sedation for fracture reduction for children presenting with extremity fracture requiring sedation for reduction. The investigators hypothesize that etomidate in combination with fentanyl will have similar reduction of distress and procedural recall as ketamine in combination with midazolam.

There are multiple retrospective studies detailing the use of etomidate in pediatric procedural sedation but few to no prospective clinical trials. None have compared etomidate to ketamine, currently the most commonly used sedative in the emergency department for pediatric procedural sedation. The investigators propose a randomized, controlled trial comparing etomidate versus ketamine for procedural sedation for fracture reduction for children presenting with extremity fracture requiring sedation for reduction. The investigators hypothesize that etomidate in combination with fentanyl will have similar reduction of distress and procedural recall as ketamine in combination with midazolam.

Inclusion Criteria:

• age 5-18 years
• extremity fracture requiring reduction with sedation in emergency department

Exclusion Criteria:

• allergy to etomidate, midazolam, fentanyl, ketamine, lidocaine
• multi-system trauma
• history of psychosis
• pregnancy
• illicit drug use
• developmental delay
• non-english speaker