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Procedural sedation and analgesia in a Canadian adult tertiary care emergency department: a case series

Published online by Cambridge University Press:  21 May 2015

Sam G. Campbell ,
Kirk D. Magee ,
George J. Kovacs ,
David A. Petrie ,
John M. Tallon ,
Robert McKinley ,
David G. Urquhart  and
Linda Hutchins
Sam G. Campbell*
Affiliation:
Department of Emergency Medicine, Dalhousie University, Halifax, NS
Kirk D. Magee
Affiliation:
Department of Emergency Medicine, Dalhousie University, Halifax, NS
George J. Kovacs
Affiliation:
Department of Emergency Medicine, Dalhousie University, Halifax, NS
David A. Petrie
Affiliation:
Department of Emergency Medicine, Dalhousie University, Halifax, NS
John M. Tallon
Affiliation:
Department of Emergency Medicine, Dalhousie University, Halifax, NS
Robert McKinley
Affiliation:
Queen Elizabeth II Health Science Centre, Halifax, NS
David G. Urquhart
Affiliation:
Department of Emergency Medicine, Dalhousie University, Halifax, NS
Linda Hutchins
Affiliation:
Queen Elizabeth II Health Science Centre, Halifax, NS
*
Department of Emergency Medicine, QE II Health Science Centre, 1796 Summer St., Halifax NS B3H 3A7, [email protected]

Abstract

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Objectives:

To examine the safety of emergency department (ED) procedural sedation and analgesia (PSA) and the patterns of use of pharmacologic agents at a Canadian adult teaching hospital.

Methods:

Retrospective analysis of the PSA records of 979 patients, treated between Aug. 1, 2004, and July 31, 2005, with descriptive statistical analysis. This represents an inclusive consecutive case series of all PSAs performed during the study period.

Results:

Hypotension (systolic blood pressure ≤ 85 mm Hg) was documented during PSA in 13 of 979 patients (1.3%; 95% confidence interval [CI] 0.3%–2.3%), and desaturation (Sao2 ≤ 90) in 14 of 979 (1.4%; CI 0.1%–2.7%). No cases of aspiration, endotracheal intubation or death were recorded. The most common medication used was fentanyl (94.0% of cases), followed by propofol (61.2%), midazolam (42.5%) and then ketamine (2.7%). The most frequently used 2-medication combinations were propofol and fentanyl (P/F) followed by midazolam and fentanyl (M/F), used with similar frequencies 58.1% (569/979) and 41.0% (401/979) respectively. There was no significant difference in the incidence of hypotension or desaturation between the P/F and M/F treated groups. In these patients, 9.1% (90/979) of patients received more than 2 different drugs.

Conclusions:

Adverse events during ED PSA are rare and of doubtful clinical significance. Propofol/fentanyl and midazolam/fentanyl are used safely, and at similar frequencies for ED PSA in this tertiary hospital case series. The use of ketamine for adult PSA is unusual in our facility.

Keywords

procedural sedationanalgesiapropofolketaminemidazolam
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 8 , Issue 2 , March 2006 , pp. 85 - 93
Copyright
Copyright © Canadian Association of Emergency Physicians 2006

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