GoStep2
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I prefer to a). Oral or rectal midazolam or diazepam
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| ARJ
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The correct answer is
A. Suturing a laceration is one of the most common situations in which sedation may be required in a child. Sedation may be classified as conscious or deep. By definition, during conscious sedation the patient is able to maintain airway patency, protective airway reflexes, and responses to physical stimuli. This level of sedation is indicated for children (or adult patients) who have not fasted prior to the procedure, or patients who do not require a deep level of sedation. Nevertheless, conscious sedation should be performed by appropriately trained personnel, and only when equipment for resuscitation measures is readily available, should the need arise. For minor surgical procedures such as suturing uncomplicated linear lacerations, administration of a short-acting or long-acting benzodiazepine (midazolam or diazepam, respectively) by the oral or rectal route provides sufficient sedation. Intravenous access is not required. Intravenous midazolam or diazepam can be used for procedures that produce more intense pain or discomfort, such as repair of complex lacerations, bone marrow aspiration, and reduction of fractures. Concomitant opioid and benzodiazepine administration (choice B) is used to achieve not only sedation, but also an adequate level of analgesia. The synergistic action of opioids and benzodiazepines increases the risk of respiratory depression. Intravenous propofol (choice C) provides rapid onset of sedation that resolves quickly once infusion is discontinued. This drug is used for procedures requiring deeper levels of sedation in appropriately fasted and stable children. Intravenous ketamine (choice D) is an appropriate alternative to propofol. Its most common side effect is the production of visual and auditory hallucinations (about 10% of cases). Concomitant analgesic-sedative agents and muscle relaxants (choice E) is employed for deep sedation and when muscle relaxation is necessary for endotracheal intubation or other diagnostic/therapeutic procedures.
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