{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T01:45:10Z","timestamp":1788918310259,"version":"build-2803163510"},"reference-count":54,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1998,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective.<\/jats:title>\n                    <jats:p>Emergency management of pediatric fractures and dislocations requires effective analgesia, yet children's pain is often undertreated. We compared the safety and efficacy of fentanyl- versus ketamine- based protocols.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology.<\/jats:title>\n                    <jats:p>Patients 5 to 15 years of age needing emergency fracture or joint reduction (FR) were randomized to receive intravenous midazolam plus either fentanyl (F\/M) or ketamine (K\/M). Measures of efficacy were observational distress scores and self- and parental-report. Measures of safety were frequency of abnormalities in and need for support of cardiopulmonary function and other adverse effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results.<\/jats:title>\n                    <jats:p>During FR, K\/M subjects (n = 130) had lower distress scores and parental ratings of pain and anxiety than did F\/M subjects (n = 130). Although both regimens equally facilitated reductions, deep sedation, and procedural amnesia, orthopedists favored K\/M. Recovery was 14 minutes longer for K\/M.<\/jats:p>\n                    <jats:p>Fewer K\/M subjects had hypoxia (6% vs 25%), needed breathing cues (1% vs 12%), or required oxygen (10% vs 20%) than did F\/M subjects. Two K\/M subjects required assisted ventilation briefly. More K\/M subjects vomited. Adverse emergence reactions were rare but equivalent between regimens.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions.<\/jats:title>\n                    <jats:p>During emergency pediatric orthopedic procedures, K\/M is more effective than F\/M for pain and anxiety relief. Respiratory complications occurred less frequently with K\/M, but respiratory support may be needed with either regimen. Both regimens facilitate reduction, produce amnesia, and rarely cause emergence delirium. Vomiting is more frequent and recovery more prolonged with K\/M.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/peds.102.4.956","type":"journal-article","created":{"date-parts":[[2004,8,13]],"date-time":"2004-08-13T19:44:32Z","timestamp":1092426272000},"page":"956-963","source":"Crossref","is-referenced-by-count":185,"title":["Comparison of Fentanyl\/Midazolam With Ketamine\/Midazolam for Pediatric Orthopedic Emergencies"],"prefix":"10.1542","volume":"102","author":[{"given":"Robert M.","family":"Kennedy","sequence":"first","affiliation":[{"name":"From the Department of Pediatrics, Divisions of Emergency Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran L.","family":"Porter","sequence":"additional","affiliation":[{"name":"Newborn Medicine, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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