Procedural Sedation and Analgesia in the Emergency Department
Official 2013 guideline from the American College of Emergency Physicians.
summary by Eric Steinberg, DO, MEHP
Preprocedure and Monitoring
Preprocedural Fasting
Do not delay procedural sedation in adults or pediatrics in the emergency department (ED) based on fasting time. Preprocedural fasting for any duration has not demonstrated a reduction in the risk of emesis or aspiration when administering procedural sedation and analgesia.
Level B
Capnography
Capnography* may be used as an adjunct to pulse oximetry and clinical assessment to detect hypoventilation and apnea earlier than pulse oximetry and/or clinical assessment alone in patients undergoing procedural sedation and analgesia in the emergency department (ED).
*Capnography includes all forms of quantitative exhaled carbon dioxide analysis.
*Capnography includes all forms of quantitative exhaled carbon dioxide analysis.
Level B
Procedure
Personnel
During procedural sedation and analgesia, a nurse or other qualified individual should be present for continuous monitoring of the patient, in addition to the provider performing the procedure. Physicians who are working or consulting in the emergency department (ED) should coordinate procedures requiring procedural sedation and analgesia with the emergency department staff.
Level C
Medications
Ketamine can be safely administered to children for procedural sedation and analgesia in the emergency department (ED). Propofol can be safely administered to children and adults for procedural sedation and analgesia in the emergency department.
Level A
Etomidate can be safely administered to adults for procedural sedation and analgesia in the emergency department (ED). A combination of propofol and ketamine can be safely administered to children and adults for procedural sedation and analgesia.
Level B
Ketamine can be safely administered to adults for procedural sedation and analgesia in the emergency department (ED). Alfentanil can be safely administered to adults for procedural sedation and analgesia in the emergency department. Etomidate can be safely administered to children for procedural sedation and analgesia in the emergency department.
Level C
What do the icons mean?
Level A
Generally accepted principles for patient care that reflect a high degree of clinical certainty (e.g. based on evidence from 1 or more Class of Evidence I or multiple Class of Evidence II studies).Level B
Recommendations for patient care that may identify a particular strategy or range of strategies that reflect moderate clinical certainty (eg, based on evidence from 1 or more Class of Evidence II studies or strong consensus of Class of Evidence III studies).Level C
Recommendations for patient care that are based on evidence from Class of Evidence III studies or, in the absence of adequate published literature, based on expert consensus. In instances in which consensus recommendations are made, “consensus” is placed in parentheses at the end of the recommendation.
