{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T23:25:52Z","timestamp":1784071552501,"version":"3.55.0"},"reference-count":24,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2024,8,18]],"date-time":"2024-08-18T00:00:00Z","timestamp":1723939200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009708","name":"Novo Nordisk Fonden","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Minor but painful medical procedures are often handled at the operating room. If safe and effective treatment options are available many procedures may be performed outside of the operating room.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective(s)<\/jats:title><jats:p>The objective of this study is to assess the adverse events of intranasal s\u2010ketamine and\/or sufentanil alone or as part of a multimodal analgesic regime for medical procedures outside of the operating room. Secondary outcomes included analgesic effect, doses and indications for use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective observational study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Tertiary care paediatric hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>Children 1\u2009year up till 18\u2009years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention(s)<\/jats:title><jats:p>Intranasal (IN) sufentanil (S), intranasal s\u2010ketamine (K) or the free combination of the two drugs (SK).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measure(s)<\/jats:title><jats:p>The frequency of adverse events including serious adverse events reported by intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between 2004 and 2014, 2185 medical procedures were registered, including 652 procedures with IN SK, 1469 procedures with IN S and 64 procedures with IN K. The children's median age was 5.6\u2009years (range 1.0\u201317.9). Medical procedures with at least one adverse event were 18% with IN SK, 25% with IN K and 18% with IN S. Common adverse events included episodes of vomiting (9%), nausea (8%) and dizziness (3%). In two patients receiving IN S, serious adverse events occurred. One patient had respiratory depression and bronchospasm and another patient with cerebral palsy had a seizure. Both were handled immediately and did not result in any sequelae. The median doses of intranasal sufentanil were 38% lower when combined with s\u2010ketamine (IN SK free combination: sufentanil dose 0.5 \u03bcg\/kg (range 0.2\u20131.3) and s\u2010ketamine dose 0.5\u2009mg\/kg (range 0.2\u20131.5). IN S monotherapy, sufentanil dose 0.8 \u03bcg\/kg (range 0.2\u20132.7)). Similar analgesic effect was reported for S and SK.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Intranasal sufentanil and\/or s\u2010ketamine are feasible for the treatment of procedural pain in an ambulatory setting with appropriate per\u2010 and post\u2010procedural observations and trained staff.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aas.14510","type":"journal-article","created":{"date-parts":[[2024,8,19]],"date-time":"2024-08-19T06:38:25Z","timestamp":1724049505000},"page":"1359-1368","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The use of intranasal sufentanil and\/or s\u2010ketamine for treatment of procedural pain in children in an ambulatory setting: A retrospective observational study"],"prefix":"10.1111","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7848-4752","authenticated-orcid":false,"given":"Bettina N.","family":"Nielsen","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology The Juliane Marie Centre, Copenhagen University Hospital  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6576-623X","authenticated-orcid":false,"given":"Steen W.","family":"Henneberg","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology The Juliane Marie Centre, Copenhagen University Hospital  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9893-890X","authenticated-orcid":false,"given":"Eva Malmros","family":"Olsson","sequence":"additional","affiliation":[{"name":"Pain Treatment Service, Astrid Lindgren Children's Hospital, Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2273-2942","authenticated-orcid":false,"given":"Stefan","family":"Lundeberg","sequence":"additional","affiliation":[{"name":"Pain Treatment Service, Astrid Lindgren Children's Hospital, Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,8,18]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2010.03411.x"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijpharm.2007.03.025"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-198805000-00003"},{"issue":"3","key":"e_1_2_11_5_1","first-page":"63","article-title":"Safety and effectiveness of intranasal administration of sedative medications (ketamine, midazolam, or sufentanil) for urgent brief pediatric dental procedures","volume":"40","author":"Abrams R","year":"1993","journal-title":"Anesth Prog"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0009-9236(96)80012-9"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03037044"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199202000-00009"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.5055\/jom.2007.0043"},{"issue":"4","key":"e_1_2_11_10_1","first-page":"114","article-title":"Intranasal sufentanil\/midazolam versus ketamine\/midazolam for analgesia\/sedation in the pediatric population prior to undergoing multiple dental extractions under general anesthesia: a prospective, double\u2010blind, randomized comparison","volume":"51","author":"Roelofse JA","year":"2004","journal-title":"Anesth Prog"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03021058"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2004.01358.x"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03011307"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1460-9592.1997.d01-93.x"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12268"},{"key":"e_1_2_11_16_1","unstructured":"The International Council for Harmonisation.Clinical safety data management: definitions and standards for expedited reporting E2A.1994."},{"key":"e_1_2_11_17_1","unstructured":"World Health Organisation.The Uppsala Monitoring Centre. 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