Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-26T07:10:34.791Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
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

References

1.Innes, G, Murphy, M, Nijssen-Jordan, C, et al. Procedural sedation and analgesia in the emergency department. Canadian Consensus Guidelines. J Emerg Med 1999;17:145–56.Google Scholar
2.Bahn, EL, Holt, KR.Procedural sedation and analgesia: a review and new concepts. Emerg Med Clin North Am 2005;23:503–17.Google Scholar
3.Miller, MA, Levy, P, Patel, MM.Procedural sedation and analgesia in the emergency department: What are the risks? Emerg Med Clin North Am 2005;23:551–72.CrossRefGoogle ScholarPubMed
4.Holger, JS, Satterlee, PA, Haugen, S.Nursing use between 2 methods of procedural sedation: midazolam versus propofol. Am J Emerg Med 2005;23:248–52.CrossRefGoogle ScholarPubMed
5.Bailey, PL, Pace, NL, Ashburn, MA, et al. Frequent hypoxemia and apnea after sedation with midazolam and fentanyl. Anesthesiology 1990;73:826–30.Google Scholar
6.Swanson, ER, Seaberg, DC, Mathias, S.The use of propofol for sedation in the emergency department. Acad Emerg Med 1996;3:234–8.Google Scholar
7.Shankar, V, Deshpande, JK.Procedural sedation in the pediatric patient. Anesthesiol Clin North Am 2005;23:635–54.CrossRefGoogle ScholarPubMed
8.Taylor, DM, O’Brien, D, Ritchie, P, et al. Propofol versus midazolam/fentanyl for reduction of anterior shoulder dislocation. Acad Emerg Med 2005;12:13–9.Google Scholar
9.Coll-Vinent, B, Sala, X, Fernandez, C, et al. Sedation for cardioversion in the emergency department: analysis of effectiveness in four protocols. Ann Emerg Med 2003;42:767–72.CrossRefGoogle ScholarPubMed
10.Godwin, SA, Caro, DA, Wolf, SJ, et al; for the American College of Emergency Physicians. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med 2005;45:177–96.Google Scholar
11.Sobel, RM, Morgan, BW, Murphy, M.Ketamine in the ED: medical politics versus patient care. Am J Emerg Med 1999;17:722–5.CrossRefGoogle ScholarPubMed
12.Guenther, E, Pribble, CG, Junkins, EP Jr, et al. Propofol sedation by emergency physicians for elective pediatric outpatient procedures. Ann Emerg Med 2003;42:783–91.CrossRefGoogle ScholarPubMed
13.Pershad, J, Godambe, SA.Propofol for procedural sedation in the pediatric emergency department. J Emerg Med 2004;27:11–4.CrossRefGoogle ScholarPubMed
14.Heuss, LT, Schnieper, P, Drewe, J, et al. Conscious sedation with propofol in elderly patients: a prospective evaluation. Aliment Pharmacol Ther 2003;17:1493–501.CrossRefGoogle ScholarPubMed
15.Miner, JR, Martel, ML, Meyer, M, et al. Procedural sedation of critically ill patients in the emergency department. Acad Emerg Med 2005;12:124–8.CrossRefGoogle ScholarPubMed
16.Weston, BR, Chadalawada, V, Chalasani, N, et al. Nurse-administered propofol versus midazolam and meperidine for upper endoscopy in cirrhotic patients. Am J Gastroenterol 2003;98:2440–7.CrossRefGoogle ScholarPubMed
17.Ulmer, BJ, Hansen, JJ, Overley, CA, et al. Propofol versus midazolam/fentanyl for outpatient colonoscopy: administration by nurses supervised by endoscopists. Clin Gastroenterol Hepatol 2003;1:425–32.Google Scholar
18.Hasen, KV, Samartzis, D, Casas, LA, et al. An outcome study comparing intravenous sedation with midazolam/fentanyl (conscious sedation) versus propofol infusion (deep sedation) for aesthetic surgery. Plast Reconstr Surg 2003;112:1683–9.CrossRefGoogle ScholarPubMed
19.Brown, TB, Lovato, LM, Parker, D.Procedural sedation in the acute care setting. Am Fam Physician 2005;71:85–90.Google ScholarPubMed
20.Vargo, JJ.Propofol: a gastroenterologist’s perspective. Gastrointest Endosc Clin N Am 2004;14:313–23.CrossRefGoogle ScholarPubMed
21.Frazee, BW, Park, RS, Lowery, D, et al. Propofol for deep procedural sedation in the ED. Am J Emerg Med 2005;23:190–5.Google Scholar
22.Green, SM.Propofol for emergency department procedural sedation – not yet ready for prime time. Acad Emerg Med 1999;6:975–8.CrossRefGoogle Scholar
23.Green, SM, Krauss, B.Propofol in emergency medicine: pushing the sedation frontier. Ann Emerg Med 2003;42:792–7.CrossRefGoogle Scholar
24.American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002;96:1004–17.CrossRefGoogle Scholar
25.Roback, MG, Wathen, JE, Bajaj, L, et al. Adverse events associated with procedural sedation and analgesia in a pediatric emergency department: a comparison of common parenteral drugs. Acad Emerg Med 2005;12:508–13.Google Scholar
26.Cromhout, A.Ketamine: its use in the emergency department. Emerg Med (Fremantle) 2003;15:155–9.Google Scholar
27.Chudnofsky, CR, Weber, JE, Stoyanoff, PJ, et al. A combination of midazolam and ketamine for procedural sedation and analgesia in adult emergency department patients. Acad Emerg Med 2000;7:228–35.Google Scholar
28.Green, SM, Sherwin, TS.Incidence and severity of recovery agitation after ketamine sedation in young adults. Am J Emerg Med 2005;23:142–4.Google Scholar
29.Miner, JR, Biros, MH, Seigel, T, et al. The utility of the bispectral index in procedural sedation with propofol in the emergency department. Acad Emerg Med 2005;12:190–6.Google Scholar
30.Soto, RG, Fu, ES, Vila, H Jr, et al. Capnography accurately detects apnea during monitored anesthesia care. Anesth Analg 2004;99:379–82.Google Scholar