Procedural Sedation and Analgesia in the Emergency Department

Points

• Depth of procedural sedation and analgesia (PSA) should be tailored to (1) the procedure, (2) the needs of the patient, and (3) the risk tolerance level.
• Consensus guidelines suggest an increased risk for adverse events in patients who are at extremes of age; have difficult neck, pharyngeal, or facial anatomy; and/or underlying disease.
• A patient should be asked about any previous experiences with sedation/anesthesia, medication allergies, current drug and alcohol use, medications, and underlying medical conditions that might augment drug metabolism.
• The Mallampati score is insensitive for predicting difficult airway management.¹¹