Safe Sedation Procedures in Adults

Authors:  Russell A Duncan, Shobhan B Thakore / Editor: Steve Fordham / Reviewer: Thomas MacMahon, Grace McKay / Codes: / Published: 19/04/2021

Before commencing this session you should complete the Module sessions on:

• Pain Management in Adult Patients
• Basic Airway Management
• The Advanced Life Support (ALS) Algorithm

Description:

This session focuses on the knowledge, skills, facilities and equipment required to perform safe emergency department procedural sedation. Commonly used sedation agents and some of their qualities are described

By the end of this session you will be able to:

• Discuss the indications for procedural sedation
• Identify at risk patients
• Identify which pharmacological agent is most appropriate in a given situation
• Describe how you would ensure your practice is safe
• Recognise pitfalls in sedation

References:

1. The Royal College of Emergency Medicine, Pharmacological Agents for Procedural Sedation and Analgesia in the Emergency Department. Best Practice Guideline. 2016: London, UK.
2. Cullinane, M., et al., Scoping our practice. The 2004 report of the National Confidential Enquiry into Patient Outcome and Death. 2004, National Confidential Enquiry into Patient Outcome and Death (NCEPOD): London, UK.
3. Academy of Medical Royal Colleges, Safe Sedation Practice for Healthcare Procedures. Standards and Guidance. 2013: London, UK.
4. The Royal College of Anaesthetists and The College of Emergency Medicine, Safe Sedation of Adults in the Emergency Department. Report and Recommendations by The Royal College of Anaesthetists and The College of Emergency Medicine Working Party on Sedation, Anaesthesia and Airway Management in the Emergency Department. 2012: London, UK.
5. Quality Management and Departmental Administration Committee, Continuum of depth of sedation: definition of general anesthesia and levels of sedation/analgesia. 2014, American Society of Anesthesiologists: Illinois, USA.
6. American Society of Anesthesiologists. ASA Physical Status Classification System. 2014 [cited 2016 04 October]
7. National Patient Safety Agency Reducing risk of overdose with midazolam injection in adults (NPSA/2008/RRR011). Rapid Response Report, 2008.
8. Newstead, B., et al., Propofol for adult procedural sedation in a UK emergency department: safety profile in 1008 cases. Br J Anaesth, 2013. 111(4): p. 651-5.
9. Bellolio, M.F., et al., Incidence of Adverse Events in Adults Undergoing Procedural Sedation in the Emergency Department: A Systematic Review and Metaanalysis. Academic Emergency Medicine, 2016. 23(2): p. 119-134.
10. Godwin, S.A., et al., Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med, 2014. 63(2): p. 247-58 e18.
11. Wakai, A., et al., The use of propofol for procedural sedation in emergency departments. Cochrane Database Syst Rev, 2015(7): p. CD007399.
12. Herres, J., et al., The use of inhaled nitrous oxide for analgesia in adult ED patients: a pilot study. Am J Emerg Med, 2016. 34(2): p. 269-73.
13. Myles, P.S., et al., A review of the risks and benefits of nitrous oxide in current anaesthetic practice. Anaesth Intensive Care, 2004. 32(2): p. 165-72.
14. General Medical Council. Consent: patients and doctors making decisions together. 2008;