Ketamine Versus Etomidate for Procedural Sedation for Pediatric Orthopedic Reductions

NCT ID: NCT00596050

Last Updated: 2017-05-09

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2006-08-31

Study Completion Date

2008-06-30

Brief Summary

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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.

Detailed Description

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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.

Conditions

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Conscious Sedation Failure During Procedure

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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ketamine and midazolam

ketamine and midazolam

Group Type ACTIVE_COMPARATOR

ketamine and midazolam

Intervention Type DRUG

ketamine 1 mg/kg/dose, midazolam 0.05 mg/kg/dose max 2 mg

etomidate and fentanyl and lidocaine

etomidate and fentanyl and lidocaine

Group Type ACTIVE_COMPARATOR

etomidate, fentanyl, and lidocaine

Intervention Type DRUG

etomidate 0.2 mg/kg/dose, fentanyl 1 microgram/kg/dose, lidocaine 0.5 mg/kg/dose

Interventions

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ketamine and midazolam

ketamine 1 mg/kg/dose, midazolam 0.05 mg/kg/dose max 2 mg

Intervention Type DRUG

etomidate, fentanyl, and lidocaine

etomidate 0.2 mg/kg/dose, fentanyl 1 microgram/kg/dose, lidocaine 0.5 mg/kg/dose

Intervention Type DRUG

Eligibility Criteria

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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
Minimum Eligible Age

5 Years

Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Drexel University College of Medicine

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jannet J Lee-Jayaram, M.D.

Role: PRINCIPAL_INVESTIGATOR

Drexel University College of Medicine

Locations

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St. Christopher's Hospital for Children

Philadelphia, Pennsylvania, United States

Site Status

Countries

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United States

References

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Bahn EL, Holt KR. Procedural sedation and analgesia: a review and new concepts. Emerg Med Clin North Am. 2005 May;23(2):503-17. doi: 10.1016/j.emc.2004.12.013.

Reference Type BACKGROUND
PMID: 15829394 (View on PubMed)

Kennedy RM, Porter FL, Miller JP, Jaffe DM. Comparison of fentanyl/midazolam with ketamine/midazolam for pediatric orthopedic emergencies. Pediatrics. 1998 Oct;102(4 Pt 1):956-63. doi: 10.1542/peds.102.4.956.

Reference Type BACKGROUND
PMID: 9755272 (View on PubMed)

Acworth JP, Purdie D, Clark RC. Intravenous ketamine plus midazolam is superior to intranasal midazolam for emergency paediatric procedural sedation. Emerg Med J. 2001 Jan;18(1):39-45. doi: 10.1136/emj.18.1.39.

Reference Type BACKGROUND
PMID: 11310461 (View on PubMed)

Gerardi MJ, Sacchetti AD, Cantor RM, Santamaria JP, Gausche M, Lucid W, Foltin GL. Rapid-sequence intubation of the pediatric patient. Pediatric Emergency Medicine Committee of the American College of Emergency Physicians. Ann Emerg Med. 1996 Jul;28(1):55-74. doi: 10.1016/s0196-0644(96)70140-3.

Reference Type BACKGROUND
PMID: 8669740 (View on PubMed)

Ruth WJ, Burton JH, Bock AJ. Intravenous etomidate for procedural sedation in emergency department patients. Acad Emerg Med. 2001 Jan;8(1):13-8. doi: 10.1111/j.1553-2712.2001.tb00539.x.

Reference Type BACKGROUND
PMID: 11136141 (View on PubMed)

Vinson DR, Bradbury DR. Etomidate for procedural sedation in emergency medicine. Ann Emerg Med. 2002 Jun;39(6):592-8. doi: 10.1067/mem.2002.123695.

Reference Type BACKGROUND
PMID: 12023700 (View on PubMed)

Dickinson R, Singer AJ, Carrion W. Etomidate for pediatric sedation prior to fracture reduction. Acad Emerg Med. 2001 Jan;8(1):74-7. doi: 10.1111/j.1553-2712.2001.tb00558.x.

Reference Type BACKGROUND
PMID: 11136155 (View on PubMed)

Schenarts CL, Burton JH, Riker RR. Adrenocortical dysfunction following etomidate induction in emergency department patients. Acad Emerg Med. 2001 Jan;8(1):1-7. doi: 10.1111/j.1553-2712.2001.tb00537.x.

Reference Type BACKGROUND
PMID: 11136139 (View on PubMed)

Godambe SA, Elliot V, Matheny D, Pershad J. Comparison of propofol/fentanyl versus ketamine/midazolam for brief orthopedic procedural sedation in a pediatric emergency department. Pediatrics. 2003 Jul;112(1 Pt 1):116-23. doi: 10.1542/peds.112.1.116.

Reference Type BACKGROUND
PMID: 12837876 (View on PubMed)

Scott J, Huskisson EC. Graphic representation of pain. Pain. 1976 Jun;2(2):175-84. No abstract available.

Reference Type BACKGROUND
PMID: 1026900 (View on PubMed)

Keim SM, Erstad BL, Sakles JC, Davis V. Etomidate for procedural sedation in the emergency department. Pharmacotherapy. 2002 May;22(5):586-92. doi: 10.1592/phco.22.8.586.33204.

Reference Type BACKGROUND
PMID: 12013357 (View on PubMed)

Mace SE, Barata IA, Cravero JP, Dalsey WC, Godwin SA, Kennedy RM, Malley KC, Moss RL, Sacchetti AD, Warden CR, Wears RL; American College of Emergency Physicians. Clinical policy: evidence-based approach to pharmacologic agents used in pediatric sedation and analgesia in the emergency department. Ann Emerg Med. 2004 Oct;44(4):342-77. doi: 10.1016/j.annemergmed.2004.04.012. No abstract available.

Reference Type BACKGROUND
PMID: 15459618 (View on PubMed)

Jay SM, Ozolins M, Elliott C, Caldwell S. Assessment of children's distress during painful medical procedures. J Health Psycho. 1983; 2: 133-147

Reference Type BACKGROUND

Other Identifiers

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Project No 1041266

Identifier Type: OTHER

Identifier Source: secondary_id

Action No 47488

Identifier Type: OTHER

Identifier Source: secondary_id

Detail No 240976

Identifier Type: OTHER

Identifier Source: secondary_id

16271

Identifier Type: -

Identifier Source: org_study_id

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