Procedural Sedation (2013)

  • Inclusion:
  • Patients of all age with emergent/urgent condition that require pain +/or anxiety management to accomplish interventional or diagnostic procedure
  • High-risk patients (cardiopulmonary d/o, multiple/head trauma, CNS depressant) w understanding that these patients are at increased risk of complications from procedural sedation and analgesia.
  • Exclusion:
    • Inhalational anesthetics
    • Analgesia for pain control without sedatives
    • Sedation solely for anxiolysis and behavioral emergencies
    • Intubated patients
  • Level A:
    • Ketamine safe for children. Propofol safe for children and adults for sedation in analgesia in ED.
  • Level B:
    • Do not delay procedural sedation in adults or pediatrics in the ED based on fasting time. Preprocedural fasting for any duration has not demonstrated a reduction in risk of emesis or aspiration
    • Capnography may be used as adjunct to pulse ox and clinical assessment to detect hypoventilation and apnea earlier than pulse ox +/or clinical assessment alone
    • Etomidate safe to adults. Combination of propofol and ketamine safe for children and adults.
  • Level C:
    • During procedural sedation and analgesia, a nurse or other qualified individual should be present for continuous monitoring, in addition to the provider performing procedure. Physicians who are working or consulting in ED should coordinate procedures.
    • Ketamine safe for adults. Alfentanil safe for adults. Etomidate safe for children.

Clinical policy: Procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2014;63:247-258. PDF

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