Comparing the Role of Auditory Soothing Effect and Ketamine on Duration of Sedation and Recovery Time in Procedural Sedation and Analgesia (PSA) Among Pediatric Patients in Emergency Department. A Case-Control Comparative Study from a Tertiary Care Setting of LIC
Authors: Siddiqui Emad Uddin , Kazi Ghazala Irfan , Qaiser Bushra , Ahmed Raheem , Siddiqui Tooba 
Published: November 2021

Abstract
Introduction: Pediatric pain, is a major concern of anxiety and fear during emergency procedures, to alleviate pediatric pain and distress different mode of sedation is required from local, nasal to parental. Appropriate pain relief with adequate sedation and analgesia different drugs are used, however, most have their side effects. Ketamine alone has been used for procedural sedation and analgesia (PSA), but a higher dose may be required to achieve adequate sedation and pain relief, leading to dose-dependent side effects. In this study, we hypothesize that cartoon music or parental/physicians soothing rhymes/sounds during PSA may reduce the dose and frequency of sedative medications, and reduce the duration of sedation and early recovery.Material and Methods: This is a prospective cross-sectional comparative hospital-based study, we used non-probability consecutive sampling from children below 16 years during 2018-2019, post ethical review board approval from Hospital Ethical Committee (3827-EM-ERC-15 (3827-EM-ERC-15{Emergency Medicine – Ethical Review Committee}), who need PSA in ED settings. The PSA was carried by ED physicians who were credentialed for PSA and advanced airway care, while the procedure will be dealt with by another physician from ED or another subspecialty. The study population was divided into two groups, one with Ketamine alone (control group) with 32 patients, while another (case group) with 60 children, who got a low dose of Ketamine along with either of the soothing auditory stimulus, like cartoon music via mobile, parental/physician rhymes during PSA. Data was entered and analyzed using SPSS version-21 Frequency and the percentage was calculated for qualitative variables. Shapiro-Wilk test was applied to check the hypothesis of normality for age (years), sedation, and recovery time, and descriptive statistics such as mean±SD, median (IQR), maximum and minimum were calculated appropriately. Effect modifiers like age, gender, sedation, and recovery time were addressed through stratification. The post-stratification chi-square test was applied by taking p ≤ 0.05 as significant.Results: Comparing the two major groups (case and control), there was no statistical difference among age, gender, types of procedures done, and recovery time, however LOS in ED (<60 minutes) and sedation time (<30 minutes) in the case group was statistically better than in control group (78% vs 87% and 85% and 78% respectively). Children with oxygen saturation ≤90% were slightly better in the case group 1.7% vs 3.1%, similarly 25% had tachycardia as compared to 28% in the ketamine-only group. Tachypnea was observed in 21.7% vs 28% among the case and control groups. Importantly ketamine repeat dose was observed in 34.4% among control (ketamine only) group and only 21.7 need repeated dose in the case group. Discussion: The goal of PSA was to relieve anxiety and fear of pain during the procedure in chaotic EDs. This will help in gaining child cooperation and parents' satisfaction along with reduced drug dose, minimizing LOS, speedy recovery time, and lessening the anticipated drug-related complications. The significant finding observed was the total sedation time and LOS in ED which was significantly better in the control group. Younger children were better soothed by parental voice (rhymes) as compared to other soothing methods examined, similarly lesser drop in oxygen saturation, minimal tachycardia or tachypnea were observed and fewer repeat doses of Ketamine was used as compared to the control group. Music during PSA demonstrates a reduction in patient anxiety, however, the dose and frequency of sedation required didn't show any such reduced medications.Conclusion: In conclusion, listening to cartoon music or parental sound/rhymes has no significant effect on the hemodynamic variables or the drug consumption among pediatric patients during PSA. By considering the reported beneficial results of previous studies, listening to music can be accepted as an adjunct non-pharmacological method for sedation.