Which medication used during IV sedation increases the risk of local anesthetic toxicity in children?

The medication that increases the risk of local anesthetic toxicity in children is fentanyl. When administering fentanyl, a potent opioid analgesic, it's important to consider its pharmacological effects on the respiratory system and potential interaction with local anesthetics.

Fentanyl can lead to increased sedation and respiratory depression, which may mask symptoms of local anesthetic toxicity. In children, who may already have varying sensitivities to medications, the combination of fentanyl with local anesthetics necessitates careful monitoring. Children can metabolize medications differently than adults, and the enhanced sedation from fentanyl can impair their ability to communicate or react to the early signs of local anesthetic toxicity.

In contrast, medications like midazolam, propofol, and ketamine, while they have their own side effects, do not specifically lead to an increased risk of local anesthetic toxicity in the same way that fentanyl does. Midazolam is primarily a sedative and anxiolytic; propofol is an anesthetic and has a rapid onset with a short duration of action; ketamine is a dissociative anesthetic with analgesic properties but does not alter the toxicity profile of local anesthetics in the same manner. These differences in pharmacodynamics highlight why fentanyl is