Key Learning Points
- Dont default to procedural sedation without considering alternative options or adjuncts to your strategy. The latter may enable you to use lighter levels of sedation.
- In your preparation for procedural sedation always ask yourself whether you would be able to ventilate and oxygenate the patient if necessary.
- The risks of aspiration, whilst small, should be considered in all patients. If a procedure is not required emergently, it may be appropriate to delay the procedure (to prolong fasting) or defer it completely in patients where aspiration risk is deemed unacceptably high.
- Use smaller initial doses of sedative in the elderly, debilitated and acutely ill patients.
- A minimum of three staff members is required for safe sedation. All sedation should take place in a resuscitation area, with full monitoring (ECG, SaO2, etCO2 and BP).
- Monitoring for 30 minutes from the last dose of sedative agent is appropriate
- IV ketamine is a safe and effective sedative agent for use in children.
- Laryngospasm is a rare but real side effect of ketamine use, and its management should be incorporated within a regular training programme.