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    Procedural Sedation and Analgesia (beta)

    Official guideline from the American College of Emergency Physicians.

    Summary by Eric Steinberg, DO
    Strength
    Level A
    Level B
    Level C

    Preprocedure and Monitoring

    Preprocedural Fasting
    1. 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.
    Capnography
    1. 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.

    Procedure

    Personnel
    1. 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.
    Medications
    1. 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.
    2. 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.
    3. 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.
    What do the icons mean?  
    Research PaperGodwin SA, Burton JH, Gerardo CJ, et al. American College of Emergency Physicians. Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department. Ann Emerg Med. 2014;63(2):247-58.e18.