Sedation methods for intra-articular corticosteroid injections in Juvenile Idiopathic Arthritis: a review.

Amit Oren-Ziv,David Hoppenstein,Yosef Uziel,Ayelet Shles

doi:10.1186/s12969-015-0021-0

Abstract

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children. Intra-articular corticosteroid injection (IASI), one of the cornerstones of treatment for this disease, is usually associated with anxiety and pain. IASI in JIA may be performed under general anesthesia, conscious sedation, or local anesthesia alone. Currently, there is no widely accepted standard of care regarding the sedation method for IASI. This review discusses the different methods of anesthesia and sedation in this procedure, emphasizing the advantages and shortcomings of each method.

Highlights

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood [1]
Intra-articular corticosteroid injections (IASI) in JIA may be performed under general anesthesia, conscious sedation, or local anesthesia alone
We reported that active participation of a medical clown during IACS with nitrous oxide for JIA further decreases pain and stress, and induces a pleasant patient experience [22]

Summary

Background

JIA is the most common rheumatic disease of childhood [1]. Management of JIA includes a combination of pharmacological interventions, physical and occupational therapy, and psychosocial support [2]. They have been reported with intramuscular, intranasal, and rectal administration of benzodiazepines [23] This method of sedation requires insertion of an intravenous cannula, which is often a distressing procedure for the children. Fentanyl Sedative-hypnotic agents, such as propofol and midazolam do not have analgesic properties and need to be combined with other analgesic agents to provide effective sedation for painful procedures. From personal experience (DH), children awakening from these short anesthetics may be distressed by the unexpected appearance of an in situ IV cannula and cannot be consoled until its removal Using both of the above methods, the child will typically emerge from anesthesia to consciousness at the end of the procedure and will be ready for home discharge in 90 minutes. For ultra-short general anesthetics, these effects appear to be rare

Conclusions

Findings

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