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Current Guidelines For Procedural Sedation In The Emergency Department

March 2010

This edition of EM Practice Guidelines Update reviews 3 clinical policies relating to sedation and analgesia in the Emergency De­partment (ED). The first 2 guidelines provide a framework for safe practice in all age groups. The final guideline discusses issues particular to the sedation of the pediatric patient.

 

Practive Guideline Impact  

 

  • Proper preparation prevents poor performance. Gathering all the equipment necessary to deal with possible catastrophes before the procedure makes catastrophes less likely to occur. 
  • Minimal and moderate sedation are appropriate for procedures that require only anxiolysis and enhanced patient comfort—procedures that in a less compassionate ED might be performed with no seda­tion at all. 
  • Most painful procedures requiring sedation in the ED need deep—rather than moderate—sedation. Choose agents with a duration of action that matches the duration of stimulation to avoid postproce­dure oversedation. 
  • If supplemental oxygen is used, strong consideration should be given to monitoring ventilatory status with quantitative continuous end-tidal CO2 (ETCO2). If this is not available, the patient should be either kept on room air or have their ventilations monitored by a second practitioner whose sole role is to perform the sedation. 
  • While aspiration is infrequent and recent food intake is not a contraindication to procedural sedation, the timing and size of the last meal should guide drug choices and depth of sedation.
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