• Emmanuelle Fauteux-Lamarre, Stephen Hearps, Michelle McCarthy, Nuala Quinn, Andrew Davidson, Donna Legge, Katherine J Lee, Greta M Palmer, Sandy M Hopper, and Franz E Babl.
• Emergency Department, Cork University Hospital, Cork, Ireland.
• Emerg Med Australas. 2024 Sep 13.

ObjectiveIntranasal (IN) fentanyl and nitrous oxide (N2O) can be combined to provide procedural sedation and analgesia to children. This combination is advantageous because of rapid onset of action and non-parenteral administration, but is associated with increased vomiting. We sought to describe the associations of demographic and procedural factors with early vomiting when using this combination in children.MethodsThis was a planned secondary analysis of a randomised controlled trial comparing the effect of oral ondansetron versus placebo at a single paediatric hospital. Children aged 3 to <18 years with planned procedural sedation with IN fentanyl and N2O were randomised to receive oral ondansetron or placebo prior to N2O administration. Vomiting was defined as early if occurring during or up to 1 h after N2O delivery. We assessed the relationship between early vomiting, demographic and procedural characteristics.ResultsParticipants were recruited between October 2016 and January 2019 and 62 out of 436 (14%) had early vomiting. The risk of early vomiting was 30% higher with higher total dose of fentanyl, risk ratio = 1.3 (95% confidence interval = 1.004-1.59). There was little evidence of a relationship between the occurrence of early vomiting and sex, age, weight, type of procedure, fasting duration, time between fentanyl administration and start of procedure, and procedure duration.ConclusionWe found that higher doses of IN fentanyl were associated with higher risk of early vomiting when administered with N2O in children. Other factors did not appear to be associated with vomiting.© 2024 The Author(s). Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.

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