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In a prospective, randomized, controlled trial, investigators compared intravenous (IV) etomidate (0.2 mg/kg) plus fentanyl (1 µg/kg) versus IV ketamine (1 mg/kg) plus midazolam (0.05 mg/kg; maximum dose, 2 mg) in a convenience sample of 23 patients (age range, 5–17 years) undergoing fracture reduction in an urban pediatric emergency department. Medications were titrated to effect; the average total amounts to achieve procedural sedation were 0.37 mg/kg for etomidate and 1.09 mg/kg for ketamine.
Pediatric emergency medicine physicians performed sedations, and orthopedic practitioners performed reductions. Procedures were videotaped and viewed by two nonphysician observers who used the validated Observational Scale for Behavioral Distress–Rev…