Paediatric procedural sedation and or analgesia in the emergency unit; A descriptive study of practice at a Ugandan Referral Hospital.

Background: Paediatric Procedural Sedation and/ or Analgesia (PPSA) is the recommended standard of practice for children undergoing painful and distressing procedures outside the operating room; however, global practice may vary. In Sub-Saharan Africa, data on the practice of PPSA is lacking. This study aimed to determine the current practice and outcomes of PPSA in the Emergency unit of Mulago National Referral Hospital to inform future standardisation of care. Methods: We conducted a descriptive study from 1st October to 31st December 2023 in the surgical section of the emergency unit of Mulago National Referral Hospital. Data was collected using specifically designed and pretested observational checklists, documenting demographics, pre-procedure assessment and preparation, intra-procedural and post-procedural care, average sedation scores attained, pain control and adverse events observed. Data was coded using EPI-Data and analysed to describe PPSA practice and outcomes. Results: We recruited 183 children undergoing procedures at the surgical section of the emergency unit. Majority were male, 104(56.8 %), and the median age (IQR) was 8 (4-12)years. Most procedures performed were orthopaedic, 149(81.4 %). Only 15(8.2 %) children got both sedation and analgesia, 4(2.2 %) got sedation only while 164(89.6 %) got analgesia only. Propofol was the most used sedative, while lignocaine with paracetamol was the most used analgesia. Most children, 92(50.3 %), had pain scores ≥8, and adverse events occurred in 6(3.3 %), all of whom belonged to the sedation and analgesia group. Anaesthetic officers were the primary providers in 75 % of the sedation-only cases and 46.7 % of the sedation and analgesia group. Conclusion: PPSA practice in this Emergency setting deviates from recommended standards with limited monitoring and inadequate pain control. The clustering of adverse events among children receiving both sedation and analgesia underscores safety risks. Safer sedative choices, clear provider roles, local guidelines, and targeted training are needed to improve the safety and quality of PPSA.