Indication	First-line agent	Pharmacologic alternatives	Notes
Foreign-body removal
Ear, children	Ketamine	Etomidate, fentanyl and midazolam	Use when suction, irrigation, or other physical measures have failed.
Rectal, adults	Etomidate	Fentanyl and midazolam, ketamine
Zipper–penile entrapment, children	Ketamine	Etomidate, fentanyl and midazolam	Consider local anesthesia.
Incision and drainage of abscess			Use if subcutaneous anesthesia is judged to beinadequate.
Adults	Etomidate	Fentanyl and midazolam, ketamine
Children	Ketamine	Etomidate, fentanyl and midazolam
Imaging in children
Acute, no suspected increase in intracranial pressure	Ketamine	Fentanyl and midazolam	Consult with on-site radiologist or subspecialist when available, timing of procedural sedation and anesthesia with imaging is key.
Acute, concern for elevated intracranial pressure	Fentanyl and midazolam	Thiopental
Outpatient younger than six years	Ketamine	Fentanyl and midazolam, chloral hydrate	Defer to preference of consulting radiologist or other subspecialist present at time of procedure.
Outpatient older than six years	Ketamine	Fentanyl and midazolam	Defer to preference of consulting radiologist or other subspecialist present at time of procedure, consider mild oral anxiolytic.
Laceration repair in children	Ketamine	Fentanyl and midazolam	Use other alternatives when possible or necessary, such as topical or subcutaneous anesthetics, topical skin adhesives, or controlled physical restraint.
Reduction, joint without fracture			Consider digital block or regional nerve block.
Adults	Etomidate	Fentanyl and midazolam, ketamine
Children	Ketamine	Etomidate, fentanyl and midazolam
Reduction, fracture with dislocation			Consider hematoma block,* digital block, or regional nerve block.
Adults	Etomidate	Fentanyl and midazolam, ketamine
Children	Ketamine	Etomidate, fentanyl and midazolam
Wound management			Consider digital or regional nerve block.
Debridement, significant pain, large surface area, severe burn
Adults	Etomidate	Fentanyl and midazolam, ketamine
Children	Ketamine	Etomidate, fentanyl and midazolam