Pedemy All toolsPick the procedure. Doses are calculated for the weight entered. Tap any earlier answer to change it.
This tool helps emergency and acute care clinicians choose a sedation or analgesia approach for children having procedures. It suggests agents by procedure type and calculates weight-based doses.
You pick the procedure: a painful procedure such as fracture reduction or abscess drainage, a simple laceration or IV in an anxious child, non-painful imaging such as CT or MRI, or anxiety before a minor procedure. The tool then checks for higher-risk features: ASA class III or higher, an abnormal airway, age under 3 months or former preterm under 60 weeks postmenstrual age, or active respiratory infection with wheeze or stridor. Any of these points to involving anesthesia or a sedation team.
Painful procedures get ketamine IV 1–1.5 mg/kg or IM 4–5 mg/kg, with intranasal fentanyl 1.5 mcg/kg for early analgesia. Lacerations get LET gel with intranasal midazolam or nitrous oxide. Imaging gets intranasal dexmedetomidine 2–3 mcg/kg or oral midazolam. Each result lists fasting times, monitoring, airway equipment, discharge criteria and reversal agents (naloxone, flumazenil). It draws on the AAP/AAPD 2019 sedation guideline, the 2011 ketamine guideline (Green et al.) and the 2014 ACEP clinical policy.
For painful procedures the tool gives ketamine IV 1–1.5 mg/kg over 30–60 seconds, repeating 0.5–1 mg/kg if needed, or IM 4–5 mg/kg if there is no IV. Ketamine is avoided under 3 months.
Intranasal fentanyl 1.5 mcg/kg (max 100 mcg), given by atomizer and split between nostrils. It may be repeated at 0.5–1 mcg/kg.
Clear fluids 2 hours, breast milk 4 hours, and formula or a light meal 6 hours. In the emergency department, recent intake is not an absolute barrier to ketamine or nitrous oxide, and urgency should be weighed.
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