Not enough evidence to determine if penthrox is more effective than ketamine in pediatric emergency medicine

Report By: Dr Devon Stride - Resident Physician
Search checked by Dr Maggie Vincent - Resident Physician
Institution: McMaster University
Date Submitted: 28th May 2021
Last Modified: 28th May 2021
Status: Blue (submitted but not checked)

Three Part Question

Is [penthrox more effective than ketamine] for [adequate procedural sedation] in [pediatric patients] in the emergency department?

Clinical Scenario

A 2 year old boy presents to the emergency department with a large laceration to his temple after he fell onto a corner of a coffee table. He will require procedural sedation to suture the laceration. You ask the bedside nurse to start an IV to administer ketamine. As the child squirms and cries getting the IV, you wonder, is there a better option?

Search Strategy

Embase 1966 to 01/2021 using the OVID interface
Medline 1996 to 01/2021 using the OVID interface
([penthrox.mp. OR exp methoxyflurane/] AND [ketamine.mp. OR exp ketamine/])

Search Outcome

464 papers, of which nine were duplicates and 455 were irrelevant.

Comment(s)

There are several studies that demonstrate the effectiveness of penthrox for procedural sedation in children, but none that use a comparator group.

Clinical Bottom Line

More comparative research is required to assess the effectiveness of penthrox for procedural sedation in children compared to ketamine in the emergency department.