Newer pharmacologic agents for procedural sedation of children in the emergency department–etomidate and propofol

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Abstract
Procedural sedation for pediatric patients having painful or anxiety-producing procedures is a necessary but often a daunting task for emergency medicine providers. This article focuses on the two agents that have most recently been described for use in this population—etomidate and propofol. Etomidate is a nonbarbiturate sedative hypnotic agent with no analgesic properties. Its rapid onset of action, short duration of action, and minimal hemodynamic effects make it an attractive agent for use in procedural sedation. Similar to previous adult studies, recent studies have shown that etomidate is both safe and effective in this pediatric population. Propofol is also a sedative hypnotic agent with rapid onset and short duration of action. Typically, it is administered as a bolus injection followed by an infusion. It has long been used for surgical procedures as well as in the intensive care unit setting, but little literature has supported its use in the pediatric emergency department. Recent studies appear to support propofol's use in this setting; however, a significant rate of side effects, including hypoxia, apnea, and decreased blood pressure, may limit its use.