Procedural sedation for fracture reduction in children with hyperactivity

Am J Emerg Med. 2008 Jul;26(6):661-4. doi: 10.1016/j.ajem.2007.10.001.


Objective: Children with attention-deficit/hyperactivity disorder (ADHD) have a higher rate of more severe injuries than the general population. However, their ADHD may cause them to respond differently to procedural sedation required for treatment. The purpose of this article is to compare procedural sedation for children with and without ADHD.

Methods: Retrospectively, 44 patients with ADHD and 41 controls sedated with fentanyl and midazolam for forearm-fracture reduction in the emergency department (ED) at a children's hospital were identified. Drug dosages, vital signs, and sedation scores were compared.

Results: Drug dosages, vital signs, and sedation scores did not significantly differ between cases and controls. Mean ED visit duration was significantly longer for patients with ADHD than for controls as was sedation duration.

Conclusions: Children with and without ADHD were equally sedated with the same total drug dosages. The differences in sedation duration and visit duration warrant further investigation.

MeSH terms

  • Adjuvants, Anesthesia / administration & dosage
  • Adolescent
  • Attention Deficit Disorder with Hyperactivity / complications*
  • Case-Control Studies
  • Chi-Square Distribution
  • Child
  • Conscious Sedation / methods*
  • Female
  • Fentanyl / administration & dosage
  • Forearm Injuries / therapy
  • Fracture Fixation*
  • Fractures, Bone / therapy*
  • Humans
  • Hypnotics and Sedatives / administration & dosage
  • Male
  • Midazolam / administration & dosage
  • Retrospective Studies
  • Treatment Outcome


  • Adjuvants, Anesthesia
  • Hypnotics and Sedatives
  • Midazolam
  • Fentanyl