Clinical PolicyClinical policy: Procedural sedation and analgesia in the emergency department
Section snippets
Preface
Emergency medicine training provides physicians with expertise in critical care, airway and pain management. Accordingly, expertise in procedural sedation and analgesia is a core competency in emergency medicine practice.1, 2 Emergency physicians routinely provide sedation, analgesia, respiratory, and hemodynamic management of critically ill patients.
Procedural sedation has received a great amount of attention in recent years. Several groups have produced documents covering its use, including
Definitions
Procedural sedation refers to a technique of administering sedatives or dissociative agents with or without analgesics to induce a state that allows the patient to tolerate unpleasant procedures while maintaining cardiorespiratory function.3 Procedural sedation and analgesia is intended to result in a depressed level of consciousness that allows the patient to maintain oxygenation and airway control independently. Moderate sedation, previously referred to as “conscious sedation,” is defined as
Methodology
This clinical policy was created after careful review and critical analysis of the peer-reviewed literature. A MEDLINE search of English-language articles published between January 1992 and January 2004 was performed using combinations of the key words “conscious sedation,” “moderate sedation,” “deep sedation,” “analgesia,” “sedation,” “standards,” “guidelines,” “complications,” and “emergency department.” Terms were then exploded as appropriate. Abstracts and articles were reviewed by
What are the personnel requirements needed to provide procedural sedation and analgesia in the ED?
Personnel providing procedural sedation and analgesia must have an understanding of the drugs administered, the ability to monitor the patient's response to the medications given, and the skills necessary to intervene in managing all potential complications.
JCAHO anesthesia standards reinforce that sedation-to-anesthesia is a continuum, and it is not always possible to predict how individual patients receiving medications will respond. It is therefore important for individual institutions to
Drug administration recommendations: can ketamine, midazolam, fentanyl, propofol, and etomidate be safely administered for procedural sedation and analgesia in the ED?
Level A recommendations. Ketamine can be safely administered to children for procedural sedation and analgesia in the ED.
Level B recommendations. Propofol can be safely administered for procedural sedation and analgesia in the ED.
Nondissociative sedation agents should be titrated to clinical effect to maximize safety during procedural sedation in the ED.
The combination of fentanyl and midazolam is effective for procedural sedation and analgesia in the ED.
Level C recommendations. Etomidate can
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Policy statements and clinical policies are the official policies of the American College of Emergency Physicians and, as such, are not subject to the same peer review process as articles appearing in the print journal. Policy statements and clinical policies of ACEP do not necessarily reflect the policies and beliefs of Annals of Emergency Medicine and its editors.