Procedural Sedation in the Emergency Department
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Jan 18, 2021
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Catalina Rodriguez Prada
https://orcid.org/0000-0001-6822-2214
Nicolás Felipe Peñaloza Rey
https://orcid.org/0000-0003-0586-0715
Jóse Fernando Parra Córdoba
https://orcid.org/0000-0002-6758-2987
Atilio Moreno Carillo
https://orcid.org/0000-0001-9148-6111
https://orcid.org/0000-0001-6822-2214
Nicolás Felipe Peñaloza Rey
https://orcid.org/0000-0003-0586-0715
Jóse Fernando Parra Córdoba
https://orcid.org/0000-0002-6758-2987
Atilio Moreno Carillo
https://orcid.org/0000-0001-9148-6111
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Abstract
Patients in the emergency department often need some painful, distressing, or unpleasant diagnostic and therapeutic procedures as part of their care. The use of various pain relievers, sedatives, and anesthetics has been described in several well-referenced guidelines. The differents options for the administration of sedation drugs in the emergency room currently allow them to be performed more effectively and safely than in past times, in addition to facilitating the carrying out of specific procedures that would otherwise require anesthesia in the operating room, thus speeding up the management of patients and reducing the length of hospital stay of patients.
Keywords
References
1. Godwin SA, Burton JH, Gerardo CJ, Hatten BW, MacE SE, Silvers SM, et al. Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department. Ann Emerg Med. 2014;63(2):247-258.e18.
2. Green SM, Roback MG, Krauss BS, Miner JR, Schneider S, Kivela PD, et al. Unscheduled Procedural Sedation: A Multidisciplinary Consensus Practice Guideline. Ann Emerg Med. 2019;73(5):e51–65.
3. Freeston JA, Leal A, Gray A. Procedural sedation and recall in the emergency department: The relationship between depth of sedation and patient recall and satisfaction (a pilot study). Emerg Med J. 2012;29(8):670–2.
4. American Society of Anesthesiologists. Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists. Anesthesiology. 2002;96:1004–17.
5. Green SM, Roback MG, Krauss BS. The Newest Threat to Emergency Department Procedural Sedation. Ann Emerg Med. 2018;72(2):115–9.
6. Godwin SA. Procedural sedation and analgesia. In: Rosen’s Emergency Medicine: Concepts and Clinical Practice. Ninth Edit. Elsevier Inc.; 2017. p. 52-61.e3.
7. Anesthesiologists A society for. Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia. Monit Anesth Care. 2019;1–2.
8. Green S, Manson K. Reformulation of the Sedation Continuum Steven. JAMA. 2010;303(9):876–7.
9. Bader AM, Pothier MM. Out-of-operating room procedures: preprocedure assessment. Anesthesiol Clin. 2009 Mar;27(1):121–6.
10. Committee AH of D. ASA Physical Status Classification System [Internet]. Available from: https://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system
11. Miner JR, Martel ML, Meyer M, Reardon R, Biros MH. Procedural sedation of critically ill patients in the emergency department. Acad Emerg Med. 2005;12(2):124–8.
12. Weaver CS, Hauter WE, Brizendine EJ, Cordell WH. Emergency department procedural sedation with propofol: is it safe? J Emerg Med. 2007 Nov;33(4):355–61.
13. Weaver CS, Terrell KM, Bassett R, Swiler W, Sandford B, Avery S, et al. ED procedural sedation of elderly patients: Is it safe? Am J Emerg Med. 2011;29(5):541–4.
14. Jonathan Benger Alasdair Gray, Gavin Lloyd, Andy Norris, Rebecca Strachan, Richard Telford LG. Safe Sedation of Adults in the Emergency Department. 2012;(November).
15. Crystal CS, McArthur TJ, Harrison B. Anesthetic and Procedural Sedation Techniques for Wound Management. Emerg Med Clin North Am. 2007;25(1):41–71.
16. Vinson DR, Hoehn C. Sedation-assisted orthopedic reduction in emergency medicine: The safety and success of a one physician/one nurse model. West J Emerg Med. 2013;14(1):47–54.
17. O’Connor RE, Sama A, Burton JH, Callaham ML, House HR, Jaquis WP, et al. Procedural sedation and analgesia in the emergency department: Recommendations for physician credentialing, privileging, and practice. Ann Emerg Med. 2011;58(4):365–70.
18. Josephy CP, Vinson DR. Feasibility of single- vs two-physician procedural sedation in a small community emergency department. Am J Emerg Med. 2018;36(6):977–82.
19. Green SM, Krauss B. Supplemental Oxygen During Propofol Sedation: Yes or No? Ann Emerg Med. 2008;52(1):9–10.
20. Mohr NM, Wessman B. Continuous capnography should be used for every emergency department procedural sedation. Ann Emerg Med. 2013 Jun;61(6):697–8.
21. Terp S, Schriger DL. Routine capnographic monitoring is not indicated for all patients undergoing emergency department procedural sedation. Ann Emerg Med. 2013 Jun;61(6):698–9.
22. Green SM, Pershad J. Should capnographic monitoring be standard practice during emergency department procedural sedation and analgesia? Pro and con. Vol. 55, Annals of emergency medicine. United States; 2010. p. 265–7.
23. Apfelbaum JL, Gross JB, Connis RT, Agarkar M, Arnold DE, Coté CJ, et al. Practice guidelines for moderate procedural sedation and analgesia 2018. Vol. 128, Anesthesiology. 2018. 437–479 p.
24. Green SM, Roback MG, Miner JR, Burton JH, Krauss B. Fasting and Emergency Department Procedural Sedation and Analgesia: A Consensus-Based Clinical Practice Advisory. Ann Emerg Med. 2007;49(4):454–61.
25. Schmitz A, Kellenberger CJ, Neuhaus D, Schroeter E, Deanovic D, Prüfer F, et al. Fasting times and gastric contents volume in children undergoing deep propofol sedation--an assessment using magnetic resonance imaging. Paediatr Anaesth. 2011 Jun;21(6):685–90.
26. Molina JAD, Lobo CA, Goh HK, Seow E, Heng BH. Review of studies and guidelines on fasting and procedural sedation at the emergency department. Int J Evid Based Healthc. 2010 Jun;8(2):75–8.
27. Miner JR, Burton JH. Clinical Practice Advisory: Emergency Department Procedural Sedation With Propofol. Ann Emerg Med. 2007;50(2).
28. Parameters P. Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures. Anesthesiology. 2017;126(3):376–93.
29. Atkinson P, French J, Nice CA. Procedural sedation and analgesia for adults in the emergency department. BMJ. 2014;348(May):1–5.
30. Myers JG, Kelly J. Procedural Sedation and Analgesia in Adults. In: Tintinalli JE, Ma OJ, Yealy DM, Meckler GD, Stapczynski JS, Cline DM, et al., editors. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9e. New York, NY: McGraw-Hill Education; 2020.
31. Green SM, Mason KP, Krauss BS. Ketamine and propofol sedation by emergency medicine specialists: Mainstream or menace? Br J Anaesth. 2016;116(4):449–51.
32. Jalili M, Bahreini M, Doosti-Irani A, Masoomi R, Arbab M, Mirfazaelian H. Ketamine-propofol combination (ketofol) vs propofol for procedural sedation and analgesia: Systematic review and meta-analysis. Am J Emerg Med. 2016;34(3):558–69.
33. Green SM, Roback MG, Kennedy RM, Krauss B. Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update. Ann Emerg Med. 2011;57(5):449–61.
34. Eich C, Verhagen-Henning S, Roessler M, Cremer F, Cremer S, Strack M, et al. Low-dose S-ketamine added to propofol anesthesia for magnetic resonance imaging in children is safe and ensures faster recovery--a prospective evaluation. Vol. 21, Paediatric anaesthesia. France; 2011. p. 176–8.
35. Zanos P, Moaddel R, Morris PJ, Riggs LM, Highland JN, Georgiou P, et al. Ketamine and Ketamine Metabolite Pharmacology: Insights into Therapeutic Mechanisms. Pharmacol Rev. 2018 Jul;70(3):621–60.
36. Bell A, Treston G, McNabb C, Monypenny K, Cardwell R. Profiling adverse respiratory events and vomiting when using propofol for emergency department procedural sedation. EMA - Emerg Med Australas. 2007;19(5):405–10.
37. Bellolio MF, Gilani WI, Barrionuevo P, Murad MH, Erwin PJ, Anderson JR, 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;23(2):119–34.
38. Levins T. Etomidate in procedural sedation. Air Med J. 2011;30(1):45–8.
39. Miner JR, Danahy M, Moch A, Biros M. Randomized clinical trial of etomidate versus propofol for procedural sedation in the emergency department. Ann Emerg Med. 2007 Jan;49(1):15–22.
40. Yates AM, Wolfson AB, Shum L, Kehrl T. A descriptive study of myoclonus associated with etomidate procedural sedation in the ED. Am J Emerg Med. 2013 May;31(5):852–4.
41. Vinca N, Barrett J, Tems CJD. Procedural sedation in the emergency department. Out Oper Room Anesth A Compr Rev. 2016;23(4):305–17.
42. Çoruh B, Tonelli MR, Park DR. Fentanyl-induced chest wall rigidity. Chest. 2013 Apr;143(4):1145–6.
43. Brown TB, Lovato LM, Parker D. Procedural sedation in the acute care setting. Am Fam Physician. 2005;71(1):85–90.
44. Pinto RF, Bhimani M, Milne WK, Nicholson K. Procedural sedation and analgesia in rural and regional emergency departments. Can J Rural Med Off J Soc Rural Physicians Canada = J Can la Med Rural le J Off la Soc Med Rural du Canada. 2013;18(4):130–6.
45. Uri O, Behrbalk E, Haim A, Kaufman E, Halpern P. Procedural sedation with propofol for painful orthopaedic manipulation in the emergency department expedites patient management compared with a midazolam/ketamine regimen: a randomized prospective study. J Bone Joint Surg Am. 2011 Dec;93(24):2255–62.
46. Sacchetti A, Senula G, Strickland J, Dubin R. Procedural Sedation in the Community Emergency Department: Initial Results of the ProSCED Registry. Acad Emerg Med. 2007;14(1):41–6.
47. McGrane O, Hopkins G, Nielson A, Kang C. Procedural sedation with propofol: A retrospective review of the experiences of an emergency medicine residency program 2005 to 2010. Am J Emerg Med. 2012;30(5):706–11.
48. Sury M, Bullock I, Rabar S, Demott K. Guidelines Sedation for diagnostic and therapeutic procedures in children and young people: summary of NICE guidance. BMJ. 2010 Dec 16;341:c6819.
49. Wood-Thompson DK, Enyuma COA, Laher AE. Procedural sedation and analgesia practices in the emergency centre. African J Emerg Med Rev africaine la Med d’urgence. 2019 Mar;9(1):8–13.
50. Chawla N, Boateng A, Deshpande R. Procedural sedation in the ICU and emergency department. Curr Opin Anaesthesiol. 2017 Aug;30(4):507–12.
2. Green SM, Roback MG, Krauss BS, Miner JR, Schneider S, Kivela PD, et al. Unscheduled Procedural Sedation: A Multidisciplinary Consensus Practice Guideline. Ann Emerg Med. 2019;73(5):e51–65.
3. Freeston JA, Leal A, Gray A. Procedural sedation and recall in the emergency department: The relationship between depth of sedation and patient recall and satisfaction (a pilot study). Emerg Med J. 2012;29(8):670–2.
4. American Society of Anesthesiologists. Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists. Anesthesiology. 2002;96:1004–17.
5. Green SM, Roback MG, Krauss BS. The Newest Threat to Emergency Department Procedural Sedation. Ann Emerg Med. 2018;72(2):115–9.
6. Godwin SA. Procedural sedation and analgesia. In: Rosen’s Emergency Medicine: Concepts and Clinical Practice. Ninth Edit. Elsevier Inc.; 2017. p. 52-61.e3.
7. Anesthesiologists A society for. Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia. Monit Anesth Care. 2019;1–2.
8. Green S, Manson K. Reformulation of the Sedation Continuum Steven. JAMA. 2010;303(9):876–7.
9. Bader AM, Pothier MM. Out-of-operating room procedures: preprocedure assessment. Anesthesiol Clin. 2009 Mar;27(1):121–6.
10. Committee AH of D. ASA Physical Status Classification System [Internet]. Available from: https://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system
11. Miner JR, Martel ML, Meyer M, Reardon R, Biros MH. Procedural sedation of critically ill patients in the emergency department. Acad Emerg Med. 2005;12(2):124–8.
12. Weaver CS, Hauter WE, Brizendine EJ, Cordell WH. Emergency department procedural sedation with propofol: is it safe? J Emerg Med. 2007 Nov;33(4):355–61.
13. Weaver CS, Terrell KM, Bassett R, Swiler W, Sandford B, Avery S, et al. ED procedural sedation of elderly patients: Is it safe? Am J Emerg Med. 2011;29(5):541–4.
14. Jonathan Benger Alasdair Gray, Gavin Lloyd, Andy Norris, Rebecca Strachan, Richard Telford LG. Safe Sedation of Adults in the Emergency Department. 2012;(November).
15. Crystal CS, McArthur TJ, Harrison B. Anesthetic and Procedural Sedation Techniques for Wound Management. Emerg Med Clin North Am. 2007;25(1):41–71.
16. Vinson DR, Hoehn C. Sedation-assisted orthopedic reduction in emergency medicine: The safety and success of a one physician/one nurse model. West J Emerg Med. 2013;14(1):47–54.
17. O’Connor RE, Sama A, Burton JH, Callaham ML, House HR, Jaquis WP, et al. Procedural sedation and analgesia in the emergency department: Recommendations for physician credentialing, privileging, and practice. Ann Emerg Med. 2011;58(4):365–70.
18. Josephy CP, Vinson DR. Feasibility of single- vs two-physician procedural sedation in a small community emergency department. Am J Emerg Med. 2018;36(6):977–82.
19. Green SM, Krauss B. Supplemental Oxygen During Propofol Sedation: Yes or No? Ann Emerg Med. 2008;52(1):9–10.
20. Mohr NM, Wessman B. Continuous capnography should be used for every emergency department procedural sedation. Ann Emerg Med. 2013 Jun;61(6):697–8.
21. Terp S, Schriger DL. Routine capnographic monitoring is not indicated for all patients undergoing emergency department procedural sedation. Ann Emerg Med. 2013 Jun;61(6):698–9.
22. Green SM, Pershad J. Should capnographic monitoring be standard practice during emergency department procedural sedation and analgesia? Pro and con. Vol. 55, Annals of emergency medicine. United States; 2010. p. 265–7.
23. Apfelbaum JL, Gross JB, Connis RT, Agarkar M, Arnold DE, Coté CJ, et al. Practice guidelines for moderate procedural sedation and analgesia 2018. Vol. 128, Anesthesiology. 2018. 437–479 p.
24. Green SM, Roback MG, Miner JR, Burton JH, Krauss B. Fasting and Emergency Department Procedural Sedation and Analgesia: A Consensus-Based Clinical Practice Advisory. Ann Emerg Med. 2007;49(4):454–61.
25. Schmitz A, Kellenberger CJ, Neuhaus D, Schroeter E, Deanovic D, Prüfer F, et al. Fasting times and gastric contents volume in children undergoing deep propofol sedation--an assessment using magnetic resonance imaging. Paediatr Anaesth. 2011 Jun;21(6):685–90.
26. Molina JAD, Lobo CA, Goh HK, Seow E, Heng BH. Review of studies and guidelines on fasting and procedural sedation at the emergency department. Int J Evid Based Healthc. 2010 Jun;8(2):75–8.
27. Miner JR, Burton JH. Clinical Practice Advisory: Emergency Department Procedural Sedation With Propofol. Ann Emerg Med. 2007;50(2).
28. Parameters P. Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures. Anesthesiology. 2017;126(3):376–93.
29. Atkinson P, French J, Nice CA. Procedural sedation and analgesia for adults in the emergency department. BMJ. 2014;348(May):1–5.
30. Myers JG, Kelly J. Procedural Sedation and Analgesia in Adults. In: Tintinalli JE, Ma OJ, Yealy DM, Meckler GD, Stapczynski JS, Cline DM, et al., editors. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9e. New York, NY: McGraw-Hill Education; 2020.
31. Green SM, Mason KP, Krauss BS. Ketamine and propofol sedation by emergency medicine specialists: Mainstream or menace? Br J Anaesth. 2016;116(4):449–51.
32. Jalili M, Bahreini M, Doosti-Irani A, Masoomi R, Arbab M, Mirfazaelian H. Ketamine-propofol combination (ketofol) vs propofol for procedural sedation and analgesia: Systematic review and meta-analysis. Am J Emerg Med. 2016;34(3):558–69.
33. Green SM, Roback MG, Kennedy RM, Krauss B. Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update. Ann Emerg Med. 2011;57(5):449–61.
34. Eich C, Verhagen-Henning S, Roessler M, Cremer F, Cremer S, Strack M, et al. Low-dose S-ketamine added to propofol anesthesia for magnetic resonance imaging in children is safe and ensures faster recovery--a prospective evaluation. Vol. 21, Paediatric anaesthesia. France; 2011. p. 176–8.
35. Zanos P, Moaddel R, Morris PJ, Riggs LM, Highland JN, Georgiou P, et al. Ketamine and Ketamine Metabolite Pharmacology: Insights into Therapeutic Mechanisms. Pharmacol Rev. 2018 Jul;70(3):621–60.
36. Bell A, Treston G, McNabb C, Monypenny K, Cardwell R. Profiling adverse respiratory events and vomiting when using propofol for emergency department procedural sedation. EMA - Emerg Med Australas. 2007;19(5):405–10.
37. Bellolio MF, Gilani WI, Barrionuevo P, Murad MH, Erwin PJ, Anderson JR, 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;23(2):119–34.
38. Levins T. Etomidate in procedural sedation. Air Med J. 2011;30(1):45–8.
39. Miner JR, Danahy M, Moch A, Biros M. Randomized clinical trial of etomidate versus propofol for procedural sedation in the emergency department. Ann Emerg Med. 2007 Jan;49(1):15–22.
40. Yates AM, Wolfson AB, Shum L, Kehrl T. A descriptive study of myoclonus associated with etomidate procedural sedation in the ED. Am J Emerg Med. 2013 May;31(5):852–4.
41. Vinca N, Barrett J, Tems CJD. Procedural sedation in the emergency department. Out Oper Room Anesth A Compr Rev. 2016;23(4):305–17.
42. Çoruh B, Tonelli MR, Park DR. Fentanyl-induced chest wall rigidity. Chest. 2013 Apr;143(4):1145–6.
43. Brown TB, Lovato LM, Parker D. Procedural sedation in the acute care setting. Am Fam Physician. 2005;71(1):85–90.
44. Pinto RF, Bhimani M, Milne WK, Nicholson K. Procedural sedation and analgesia in rural and regional emergency departments. Can J Rural Med Off J Soc Rural Physicians Canada = J Can la Med Rural le J Off la Soc Med Rural du Canada. 2013;18(4):130–6.
45. Uri O, Behrbalk E, Haim A, Kaufman E, Halpern P. Procedural sedation with propofol for painful orthopaedic manipulation in the emergency department expedites patient management compared with a midazolam/ketamine regimen: a randomized prospective study. J Bone Joint Surg Am. 2011 Dec;93(24):2255–62.
46. Sacchetti A, Senula G, Strickland J, Dubin R. Procedural Sedation in the Community Emergency Department: Initial Results of the ProSCED Registry. Acad Emerg Med. 2007;14(1):41–6.
47. McGrane O, Hopkins G, Nielson A, Kang C. Procedural sedation with propofol: A retrospective review of the experiences of an emergency medicine residency program 2005 to 2010. Am J Emerg Med. 2012;30(5):706–11.
48. Sury M, Bullock I, Rabar S, Demott K. Guidelines Sedation for diagnostic and therapeutic procedures in children and young people: summary of NICE guidance. BMJ. 2010 Dec 16;341:c6819.
49. Wood-Thompson DK, Enyuma COA, Laher AE. Procedural sedation and analgesia practices in the emergency centre. African J Emerg Med Rev africaine la Med d’urgence. 2019 Mar;9(1):8–13.
50. Chawla N, Boateng A, Deshpande R. Procedural sedation in the ICU and emergency department. Curr Opin Anaesthesiol. 2017 Aug;30(4):507–12.
How to Cite
Rodriguez Prada, C., Peñaloza Rey, N. F., Parra Córdoba, J. F., & Moreno Carillo, A. (2021). Procedural Sedation in the Emergency Department. Universitas Medica, 62(1). https://doi.org/10.11144/Javeriana.umed62-1.seda
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