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Anxiolysis for laceration repair in children: a survey of pediatric emergency providers in Canada

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Abstract

Objectives

Intranasal dexmedetomidine is a potentially effective anxiolytic but its role in pediatric laceration repair is only emerging. Future trials and clinical adoption of intranasal dexmedetomidine depend on understanding pediatric emergency providers’ practice patterns surrounding anxiolysis and perceived barriers to intranasal dexmedetomidine for anxiolysis during suture repair in children. Our objectives were to characterize these parameters to inform future research and facilitate clinical adoption.

Methods

We conducted an online survey of pediatric emergency physician members of Pediatric Emergency Research Canada from September to December 2020. Questions pertained to perceptions of anxiolysis for suture repair, with a focus on intranasal dexmedetomidine. The primary outcome was anxiolysis for suture repair. Data were reported using descriptive statistics.

Results

The response rate was 155/225 (68.9%). During suture repair, 127/148 (86%) believed that > 25% of young children experience distress requiring physical restraint. 116/148 (78%) would provide anxiolysis, mainly intranasal benzodiazepines (100/148, 68%). Only 6/148 (4%) would provide intranasal dexmedetomidine but 95/148 (64%) would consider it if there was evidence of benefit. The most common perceived barriers to intranasal dexmedetomidine included inadequate personal experience (114/145, 79%) and lack of access (60/145, 41%).

Conclusions

Most Canadian pediatric emergency providers believe that laceration repair in a young child is distressing. Despite questionable efficacy, most would provide intranasal benzodiazepines, but would consider intranasal dexmedetomidine if there was evidence of benefit.

Résumé

Objectifs

La dexmédétomidine intranasale est un anxiolytique potentiellement efficace mais son rôle dans la réparation des lacérations en pédiatrie n'est qu'émergent. Les futurs essais et l'adoption clinique de la dexmédétomidine intranasale dépendent de la compréhension des habitudes de pratique des urgentistes pédiatriques en matière d'anxiolyse et des obstacles perçus à la dexmédétomidine intranasale pour l'anxiolyse pendant la réparation des sutures chez les enfants. Nos objectifs étaient de caractériser ces paramètres pour éclairer les recherches futures et faciliter l'adoption clinique.

Méthodes

Nous avons mené un sondage en ligne auprès des médecins urgentistes pédiatriques membres de Recherche en urgence pédiatrique Canada (Pediatric Emergency Research Canada) de septembre à décembre 2020. Les questions portaient sur les perceptions de l'anxiolyse pour la réparation des sutures, en mettant l'accent sur la dexmédétomidine intranasale. Le résultat principal était l'anxiolyse pour la réparation des sutures. Les données ont été rapportées à l'aide de statistiques descriptives.

Résultats

Le taux de réponse était de 155/225 (68,9 %). Pendant la suture, 127/148 (86 %) ont estimé que > 25 % des jeunes enfants éprouvent une détresse nécessitant une contention physique. 116/148 (78 %) fourniraient une anxiolyse, principalement des benzodiazépines intranasales (100/148, 68 %). Seulement 6/148 (4 %) fourniraient de la dexmédétomidine intranasale, mais 95/148 (64 %) l’envisageraient s’il y avait une preuve de bénéfice. Les obstacles les plus fréquemment perçus à la dexmédétomidine intranasale étaient une expérience personnelle insuffisante (114/145, 79 %) et un manque d'accès (60/145, 41 %).

Conclusions

La plupart des fournisseurs canadiens de services d’urgence pédiatriques croient que la réparation des lacérations chez un jeune enfant est pénible. En dépit d'une efficacité douteuse, la plupart d'entre eux fourniraient des benzodiazépines intranasales, mais envisageraient la dexmédétomidine intranasale s'il était prouvé qu'elle était bénéfique.

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Funding

Department of Paediatrics Resident Research Grant.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

    Kriti Kumar & Leslie Boisvert

  2. Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children’s Health Research Institute, University of Alberta, Edmonton, AB, Canada

    Samina Ali

  3. Department of Pediatrics, Faculty of Medicine, British Columbia Children’s Hospital, University of British Columbia, Vancouver, BC, Canada

    Vikram Sabhaney

  4. Département d’Urgence Pédiatrique, CHU Sainte-Justine, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada

    Evelyne Trottier

  5. Department of Pediatrics, Children’s Hospital of Wisconsin, Milwaukee, WI, USA

    Amy Drendel

  6. Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada

    Maala Bhatt

  7. Departments of Paediatrics, Internal Medicine, Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 800 Commissioners Road East, London, ON, N6A 2V5, Canada

    Naveen Poonai

  8. Division of Pediatric Emergency Medicine, Children’s Health Research Institute, London Health Sciences Centre, London, ON, Canada

    Naveen Poonai

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  1. Kriti Kumar
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  8. Naveen Poonai
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Pediatric Emergency Research Canada

Corresponding author

Correspondence to Naveen Poonai.

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Kumar, K., Ali, S., Sabhaney, V. et al. Anxiolysis for laceration repair in children: a survey of pediatric emergency providers in Canada. Can J Emerg Med 24, 75–83 (2022). https://doi.org/10.1007/s43678-021-00210-y

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  • DOI: https://doi.org/10.1007/s43678-021-00210-y

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