Propofol has been gaining increased attention as a sole agent in providing procedural sedation due to its predictable pharmacokinetics and favorable amnestic properties. Oral and maxillofacial surgical procedures are unique in duration and concomitant use of local anesthesia making it difficult to evaluate data obtained from other specialties. The purpose of our study is to evaluate the safety, efficacy and satisfaction among surgeons and patients using propofol only, for procedural sedation during the extraction of third molars. Propofol 10mg/ml was administered using an induction dose of 0.5 to 1mg/kg over 60 seconds followed by bolus doses of 10 – 20mg every minute to achieve a Ramsay sedation score of at least 3. Respiratory compromise was identified in 15% of patients. Hemodynamic compromise was identified in 15%. Patient and surgeon satisfaction was high however propofol does not represent the ideal drug as a sole agent for procedural sedation in oral surgery due to the frequent need for hand restraint (40%).

When pediatric patients are admitted to the inpatient or outpatient hospital setting they potentially have to endure procedures that cause pain, fear, and anxiety which can have a lifelong impact on the child's response to future healthcare needs. The purpose of this project was to create a comprehensive program proposal for a nitrous oxide sedation program to minimize those perceptions towards medical procedures. The project utilized a systematic review of literature and secondary data to address the most important indicators for developing a comprehensive program proposal to present to the pediatric leadership team. Multiple studies have shown nitrous oxide having an excellent safety profile in the pediatric population while providing an almost pain and anxiety free procedure. The program proposal will be used to improve pain and anxiety management for pediatric patients requiring procedures such as intravenous access, venipuncture, voiding cystourethrograms, lumbar puncture, bone marrow biopsy, port-a-cath access, PICC line insertion, dressing changes, chest tubes, and wound care. Key stakeholders and content experts were brought together to create the nitrous oxide program proposal which included a new practice guideline, a comprehensive policy and procedure for nitrous oxide administration, and an education plan. The program proposal included other key components necessary for a safe and efficient program such as a pre-assessment to determine if the child is a candidate, monitoring and documentation of nitrous oxide administration, and education for the child/parent(s). The nitrous oxide program for pediatrics was designed as a minimal sedation method to minimize procedural pain, fear, and anxiety in children where medical procedures are a necessary part of treatment.

Background Procedural sedation and analgesia (PSA) is considered a core competency in emergency medicine as patients present to the Emergency Centre (EC) on an unscheduled basis, often complex complaints that necessitate emergent management (1). Previous evidence has consistently shown that procedural sedation and analgesia(PSA) in the EC in the paediatric population, even the very young, is safe if appropriate monitoring is performed and appropriate medications are used (2–5). The aim of the study was to describe the indications for PSA in the paediatric EC population, the fasting status of paediatric patients undergoing PSA, and the complications observed during PSA in a single Western Cape emergency centre. Methods A retrospective, descriptive study was conducted at Mitchells Plain Hospital, a district-level hospital situated in Mitchells Plain, Cape Town. All paediatric patients younger than 13 years of age who presented to the EC and received PSA during the study period (December 2020 – April 2021) were included in the study. Data was extracted from a standardised PSA form and simple descriptive statistics were used. Results A total of 116 patients (70,7% male) were included: 13 infants (<1 year of age) 48 young children (1-5 years of age) and 55 older children (5-13 years of age). There were only 2 (1,7%) complications documented, both of which were vomiting and did not require admission. The most of patients received ketamine (93,1%). The standardised PSA form was completed in 49,1% of cases. Indications for PSA included burns debridement (11,2%), suturing (17,2%), fracture reduction (23,3%), lumbar punctures (31,9%) and others (27,6%). The indications for PSA varied between the different age groups. Conclusion The study findings are in accordance with previous international literature. Emergency Centre PSA in the paediatric populations did not show an increase in interventions or complications, despite the fasting status (6). Safe, timely PSA with minimal pain and unnecessary suffering can become the norm in Emergency Medicine practice in South Africa.

Procedursmärta är den vanligaste orsaken till smärta hos barn i sjukvården. Dagligen genomförs diagnostiska och terapeutiska procedurer på barn, som både är skrämmande och smärtsamma. Barn som upplever otillräcklig smärtlindring under medicinska procedurer har en högre nivå av rädsla och ångest inför framtida procedurer, de reagerar dessutom kraftigare på akut smärta. Att låta barn inhalera en blandning av lustgas och syrgas ger både en smärtlindring och sedering. Stor fördel är att lustgas är enkel att administrera, har en kort anslagstid och effekten avklingar snabbt när inhalationen avslutas, och ger få biverkningar. Syftet med litteraturstudien var att beskriva effekten av lustgas i samband med att barn utsätts för smärtsamma procedurer inom hälso- och sjukvården. En litteraturstudie utfördes där tio vetenskapliga studier grundlade resultetet. Vid bearbetningen identifierades tre olika teman, dessa var; Lustgas och smärta, Lustgas och biverkningar, Lustgas och fasta. I resultatet framkom att lustgassedering är en effektiv och säker metod för att uppnå smärtlindring och sedering under mindre, men smärtsamma medicinska procedurer, med få biverkningar. Allt fler barn sederas med lustgas vid olika medicinska procedurer av icke anestesiutbildade sjuksköterskor. En konklusion av resultatet var, för att sjuksköterskan ska kunna möta kraven måste systematisk utbildning och träning finnas och tydliga guidelines utarbetas och vara förankrad hos all personal. Detta måste prioriteras, förbättras och kontinuerligt uppdateras.