Authors: Russell A Duncan, Shobhan B Thakore / Editor: Steve Fordham / Reviewer: Thomas MacMahon, Grace McKay, Mohamed Gresha / Codes: / Published: 19/04/2021 / Reviewed: 08/09/2025
Before commencing this session you should complete the modules:
This module focuses on the knowledge, skills, facilities and equipment required to perform safe procedural sedation in the emergency department (ED). 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
- The Royal College of Emergency Medicine. Procedural Sedation in the Emergency Department. Best Practice Guideline. August 2022.
- Academy of Medical Royal Colleges, Safe Sedation Practice for Healthcare Procedures. Standards and Guidance. 2013: London, UK.
- 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.
- Academy of Medical Royal Colleges. Safe sedation practice for healthcare procedures, An update. Feb 2021.
- American Society of Anesthesiologists. Statement on Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia. Committee on Quality Management and Departmental Administration. Last Amended: October 23, 2024. Illinois, USA.
- Green SM, Roback MG, et al. Unscheduled Procedural Sedation: A Multidisciplinary Consensus Practice Guideline. Ann Emerg Med. 2019 May;73(5):e51-e65.
- National Patient Safety Agency Reducing risk of overdose with midazolam injection in adults (NPSA/2008/RRR011). Rapid Response Report, 2008.
- Godwin SA, Burton JH, et al. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2014 Feb;63(2):247-58.e18.
- Bellolio MF, Gilani WI, et al. Incidence of Adverse Events in Adults Undergoing Procedural Sedation in the Emergency Department: A Systematic Review and Meta-analysis. Acad Emerg Med. 2016 Feb;23(2):119-34.
- Wakai A, Blackburn C, McCabe A, et al. The use of propofol for procedural sedation in emergency departments. Cochrane Database Syst Rev. 2015 Jul 29;2015(7):CD007399.
- Herres J, Chudnofsky CR, et al. The use of inhaled nitrous oxide for analgesia in adult ED patients: a pilot study. Am J Emerg Med. 2016 Feb;34(2):269-73.
- Myles PS, Leslie K, Silbert B, Paech MJ, Peyton P. A review of the risks and benefits of nitrous oxide in current anaesthetic practice. Anaesth Intensive Care. 2004 Apr;32(2):165-72.
- American Society of Anesthesiologists. ASA Physical Status Classification System. 2014 [cited June 24 2025].
- General Medical Council. Decision making and consent: patients and doctors making decisions together.
- Newstead B, Bradburn S, Appelboam A, et al. Propofol for adult procedural sedation in a UK emergency department: safety profile in 1008 cases. Br J Anaesth. 2013 Oct;111(4):651-5.
