Procedural sedation and analgesia

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Procedural sedation is defined as "a technique of administering sedatives or dissociative agents with or without analgesics to induce a state that allows the patient to tolerate unpleasant procedures while maintaining cardiorespiratory function."[1] It was previously referred to as conscious sedation.

Contents

Indications

This technique is often used in the emergency department for the performance of painful or uncomfortable procedures. It has been used for setting fractures, draining abscesses, reducing dislocations, performing endoscopy, imaging procedures in patients unable to hold still, cardioversion[2] and during dental procedures.

Agents used

Sedatives/dissociative agents

Analgesics

  • Fentanyl
  • Morphine
  • Ketamine: Small doses of ketamine have been found to be safer than fentanyl when used in combination with propofol.[4]

Techniques

For most agents the person should have had nothing to eat for at 6 hours. Clear fluids can be allowed up to two hours before the procedure. An exception to this may be with ketamine in children where fasting may be unnecessary.[5]

Complications

Complications depend on the sedative agent that is used. Many commonly used agents can cause respiratory depression, hypoxia and hemodynamic effects. For some agents antagonists are available that can be used to reverse the effects.

Safety

Procedural sedation can be safely performed in an emergency department if structured sedation protocols are followed.[6]

Electrocardiography, pulse oximetry, capnography and blood pressure monitoring are essential, as is the use of supplementary oxygen.

Protocols

Many institutions have protocols that are used during procedural sedation.

Controversies

Some resistance to sedation techniques used outside the operating room by non-anesthetists has been voiced.[7]

History

Procedural sedation used to be referred to as conscious sedation.

See also

References

  1. "Procedural Sedation: - eMedicine". http://emedicine.medscape.com/article/109695-overview. 
  2. "Procedural Sedation for Cardioversion". http://www.bestbets.org/bets/bet.php?id=977. 
  3. 3.0 3.1 Hohl, CM.; Sadatsafavi, M.; Nosyk, B.; Anis, AH. (Jan 2008). [Expression error: Missing operand for > "Safety and clinical effectiveness of midazolam versus propofol for procedural sedation in the emergency department: a systematic review."]. Acad Emerg Med 15 (1): 1–8. doi:10.1111/j.1553-2712.2007.00022.x. PMID 18211306. 
  4. Messenger DW, Murray HE, Dungey PE, van Vlymen J, Sivilotti ML (October 2008). [Expression error: Missing operand for > "Subdissociative-dose ketamine versus fentanyl for analgesia during propofol procedural sedation: a randomized clinical trial"]. Acad Emerg Med 15 (10): 877–86. doi:10.1111/j.1553-2712.2008.00219.x. PMID 18754820. 
  5. "BestBets: Does the time of fasting affect complication rates during ketamine sedation". http://www.bestbets.org/bets/bet.php?id=866. 
  6. Ip U, Saincher A (January 2000). "Safety of pediatric procedural sedation in a Canadian emergency department". CJEM 2 (1): 15–20. PMID 17637112. http://caep.ca/template.asp?id=A657D85EDAE94D9E966CFD4DD617C281. 
  7. Krauss B, Green SM (March 2006). [Expression error: Missing operand for > "Procedural sedation and analgesia in children"]. Lancet 367 (9512): 766–80. doi:10.1016/S0140-6736(06)68230-5. PMID 16517277. 

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