• LamSamuel H FSHFDepartment of Emergency Medicine, University of California, San Diego, San Diego, California., David R Li, Christian E Hong, and Gary M Vilke.
• Department of Emergency Medicine, University of California, San Diego, San Diego, California.
• J Emerg Med. 2018 Jul 1; 55 (1): 516351-63.

BackgroundPer rectum (PR) medication delivery is an alternative to traditional oral (PO), intravenous (IV), or intramuscular (IM) administration of medication for procedural sedation of pediatric emergency department patients. However, many emergency physicians are unfamiliar with its use, and there are no widely adopted guidelines or reviews dedicated to this topic.ObjectiveOur aim was to provide emergency physicians with an overview of PR procedural sedation medications in pediatric patients.MethodsWe performed a PubMed literature search of relevant keywords limited to studies of human subjects published in English between January 1, 1990 and December 31, 2017. We excluded case reports, general review articles, editorial/opinion pieces, correspondence, and abstracts. Two of the authors then conducted a structured review of the selected studies.ResultsA total of 315 PubMed citations meeting the search criteria were found. Twenty-eight articles were included for final detailed review. Only 4 of the 28 included studies were conducted in the emergency department setting. A total of 9 different medications have been studied for PR procedural sedation. Sedation effectiveness ranged from 40% to 98%. No life-threatening complications were reported in any of the included clinical trials. Hypoxia was found to occur in up to 10% of those receiving PR sedation.ConclusionsPediatric procedural sedation with PR medications appears to be feasible, moderately effective, and safe based on our review of the current literature. However, further studies on its applicability in the emergency department setting are needed.Copyright © 2018 Elsevier Inc. All rights reserved.

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