Procedural Sedation in Emergency Medicine 2024

Author: Gavin Lloyd / Editors: Steve Fordham, William Gibbs / Reviewer: Mehdi Teeli / Code: / Published: 11/03/2021 / Reviewed: 13/09/2024

This module covers indications for procedural sedation, discusses how to identify patients at risk and how to ensure that your practice is safe.

After completing this module you will be able to:

  • Discuss the indications for procedural sedation
  • Identify at risk patients
  • Decide which pharmacological agent is most appropriate
  • Ensure that your practice is safe
  • Consider modifications to your practice for children

References

  1. American Society of Anesthesiologists (ASA), Statement on Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia. Committee on Quality Management and Departmental Administration, October 2019.
  2. The Royal College of Emergency Medicine (RCEM). Curriculum 2021. 04 August 2021.
  3. The Royal College of Emergency Medicine (RCEM) Best Practice Guideline, Procedural Sedation in the Emergency Department, August 2022.
  4. Cook TM, Andrade J, Bogod DG, et al. Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland. The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent and medicolegal issues. Anaesthesia. 2014 Oct;69(10):1102-16.
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  18. Green SM, Rothrock S, Lynch E, et al. Intramuscular Ketamine for Pediatric Sedation in the Emergency Department: Safety Profile in 1,022 Cases. Ann Emerg Med 1998; 31:688-697
  19. The Royal College of Emergency Medicine. Ketamine Procedural Sedation for Children in the Emergency Department. Revised Feb 2020
  20. Wathen JE, Roback MG, Mackenzie T, et al. Does midazolam alter the clinical effects of intravenous ketamine sedation in children? A double-blind, randomized, controlled emergency department study. Ann Emerg Med 2000; 36: 7988.
  21. Sherwin TS, Green SM, Khan A, et al. Does adjunctive midazolam reduce recovery agitation after ketamine sedation for pediatric procedures? A randomized, double-blind, placebo- controlled trial. Ann Emerg Med 2000; 35: 22938
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