Unconscious sedation in children: a prospective multi-arm clinical trial

Background: We report the evaluation of six sedative-hypnotic and analgesic combinations administered to children undergoing brief periods of unconscious (or deep) sedation for painful procedures. Methods: In a prospective, open-label, randomized, controlled study of six groups of 27-30 children each, patients were randomly assigned to receive propofol or methohexital for sedation-hypnosis, and one of three incremental doses of fentanyl or remifentanil, respectively. Results: An infusion of methohexital (10 mg.ml(-1)) combined with remifentanil (6.67 mug.ml(-1)) provided significantly shorter geometric mean times to initial emergence, to eye-opening and to discharge, and required airway interventions that were not significantly more frequent than all groups sedated with propofol and fentanyl. Conclusions: The combination of methohexital and remifentanil appears to be a satisfactory method for unconcious sedation for short painful procedures in children.