Systematic Review: Rectal Administration of Medications for Pediatric Procedural Sedation

J Emerg Med. 2018 Jul;55(1):51-63. doi: 10.1016/j.jemermed.2018.04.025. Epub 2018 May 24.


Background: Per rectum (PR) medication delivery is an alternative to traditional oral (PO), intravenous (IV), or intramuscular (IM) administration of medication for procedural sedation of pediatric emergency department patients. However, many emergency physicians are unfamiliar with its use, and there are no widely adopted guidelines or reviews dedicated to this topic.

Objective: Our aim was to provide emergency physicians with an overview of PR procedural sedation medications in pediatric patients.

Methods: We performed a PubMed literature search of relevant keywords limited to studies of human subjects published in English between January 1, 1990 and December 31, 2017. We excluded case reports, general review articles, editorial/opinion pieces, correspondence, and abstracts. Two of the authors then conducted a structured review of the selected studies.

Results: A total of 315 PubMed citations meeting the search criteria were found. Twenty-eight articles were included for final detailed review. Only 4 of the 28 included studies were conducted in the emergency department setting. A total of 9 different medications have been studied for PR procedural sedation. Sedation effectiveness ranged from 40% to 98%. No life-threatening complications were reported in any of the included clinical trials. Hypoxia was found to occur in up to 10% of those receiving PR sedation.

Conclusions: Pediatric procedural sedation with PR medications appears to be feasible, moderately effective, and safe based on our review of the current literature. However, further studies on its applicability in the emergency department setting are needed.

Keywords: pediatric; rectal; review; sedation.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Administration, Rectal*
  • Chloral Hydrate / administration & dosage
  • Chloral Hydrate / therapeutic use
  • Conscious Sedation / methods
  • Conscious Sedation / standards*
  • Diazepam / administration & dosage
  • Diazepam / therapeutic use
  • Emergency Service, Hospital / organization & administration
  • Humans
  • Hypnotics and Sedatives / administration & dosage*
  • Hypnotics and Sedatives / therapeutic use
  • Ketamine / administration & dosage
  • Ketamine / therapeutic use
  • Methohexital / administration & dosage
  • Methohexital / therapeutic use
  • Midazolam / administration & dosage
  • Midazolam / therapeutic use
  • Pediatrics / methods
  • Pediatrics / trends


  • Hypnotics and Sedatives
  • Chloral Hydrate
  • Ketamine
  • Methohexital
  • Diazepam
  • Midazolam