No need to wait to give kids sedation in ER: study

Research finds no evidence that hours of fasting make it safer for patients

Children who need emergency sedation to set broken bones or stitch complex cuts are often forced to wait hours in hospital emergency departments because of guidelines requiring fasting before sedation.

That might soon change as a result of a study co-authored by CHEO’s Dr. Maala Bhatt that included close to 1,000 patients from that hospital, among 6,200 Canadian children.

The study, published in JAMA Pediatrics this week, found that there is no link between the amount of time a child had fasted before being sedated and adverse events, meaning there is no evidence that delaying sedation is safer for children.

Bhatt, who is director of pediatric emergency research at CHEO and an emergency physician, said fasting has traditionally been thought to decrease adverse events related to sedation, especially aspiration, which is the inhaling of a fluid such as vomit.

Under guidelines followed in CHEO and many hospitals, patients must fast at least six hours between eating solid food and sedation, and must wait two to four hours after consuming liquids.

That means young patients who arrive at CHEO emergency in need of sedation to set a broken bone or stitch a cut are often given pain medication and forced to wait hours for the procedure.

“You can imagine what it does to not only (patient) flow, but also to these poor families,” Bhatt said. “We treat the pain, but it is not very relaxing … and we prolong their anxiety and definitive treatment.”

Bhatt noted aspiration, which is the most feared adverse effect of sedation, has never been documented among children being sedated in emergency rooms. Emergency sedations are generally shorter and less complex than sedations in operating rooms, where fasting guidelines are in place. The guidelines were developed for patients sedated for planned procedures.

The study followed 6,200 children across Canada who needed sedation during a visit to an emergency room.

Since some hospitals observe fasting guidelines in their emergency departments and some don’t, about half of the children in the study had not fasted before being sedated.

The study — the largest and most thorough of its kind to date — answered the question of whether fasting makes patients safer.

“We’ve shown that we can give children emergency procedures that require sedation without waiting and still keep them safe,” Bhatt said.

“By not having to delay a proce- dure requiring sedation, we can reduce worry for children, youth and families and reduce the time they spend in the emergency department.”

The next step, she said, is using the research to push for policy change at hospitals, including CHEO.