Challenges in procedural sedation and analgesia in the emergency department

Raffay, Violetta; Fiser, Z; Samara, Evangelia; Magounaki, Kalliopi; Chatzis, Dimitrios; Mavrovounis, Georgios; Mermiri, Maria; Zunic, Filip; Pantazopoulos, Ioannis

doi:10.21037/jeccm-19-212

Cited by 3 publications

(4 citation statements)

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“…The pre-sedation assessment will allow to identify possible risks that will lead to a modification of the perioperative care in order to reduce the likelihood of adverse events and develop an appropriate sedation plan [6][7][8][9].…”

Section: May Require Assistancementioning

confidence: 99%

“…The administration of procedural sedation and analgesia (PSA) in the emergency department (ED) represents a cornerstone of modern emergency medicine, enabling clinicians to perform potentially painful or distressing procedures with minimal patient discomfort and stress, while preserving vital physiological functions [1,2]. This practice necessitates a sophisticated understanding of pharmacology to select and administer sedative and analgesic agents that are best suited to the patient's needs and the specific procedural requirements [3,4].Agents such as propofol, ketamine, dexmedetomidine, fentanyl, midazolam, etomidate, nitrous oxide, and the innovative benzodiazepine remimazolam, each with distinct pharmacokinetic and pharmacodynamic profiles, are judiciously evaluated to ensure their optimal application in procedural sedation [5][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Procedural Sedation in Emergency Department: A Narrative Review

Cappellini,

Bavestrello Piccini,

Campagnola

et al. 2024

Preprint

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Procedural Sedation and Analgesia (PSA) in the Emergency Department (ED) presents a crucial aspect of emergency medicine, enabling the execution of painful or distressing procedures with minimal patient discomfort. This narrative review delineates the pharmacological framework, methodologies, and clinical considerations integral to optimizing PSA, with a particular focus on pediatric and geriatric populations. Through a comprehensive review and analysis of current practices, this work evaluates the pharmacokinetics and pharmacodynamics of widely utilized sedatives and analgesics, including propofol, ketamine, dexmedetomidine, fentanyl, midazolam, etomidate, nitrous oxide, and remimazolam. Special attention is dedicated to the selection criteria based on patient-specific risk factors, procedural requirements, and the management of potential adverse effects. The manuscript also explores innovative sedation techniques and the integration of new pharmacological agents, emphasizing evidence-based approaches to enhance patient safety and outcome. Results underscore the significance of tailored sedation strategies, especially for vulnerable groups such as pediatric and geriatric patients, highlighting the need for meticulous pre-procedural assessment and monitoring to mitigate risks. Conclusions drawn advocate for a nuanced application of PSA, guided by current evidence and clinical guidelines, to improve the quality of care in emergency settings. This research reinforces the imperative for ongoing education, skill development, and adaptation of new evidence into clinical practice to advance procedural sedation and analgesia in the ED.

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Section: May Require Assistancementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Procedural Sedation in Emergency Department: A Narrative Review

Cappellini,

Bavestrello Piccini,

Campagnola

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…This practice necessitates a sophisticated understanding of pharmacology to select and administer sedative and analgesic agents that are best suited to the patient's needs and the specific procedural requirements [1,3]. Agents such as propofol, ketamine, dexmedetomidine, fentanyl, midazolam, etomidate, nitrous oxide, and the innovative benzodiazepine remimazolam, each with distinct pharmacokinetic and pharmacodynamic profiles, are judiciously evaluated to ensure their optimal application in procedural sedation [4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…The pre-sedation assessment will allow one to identify possible risks that will lead to a modification of the perioperative care in order to reduce the likelihood of adverse events and develop an appropriate sedation plan [4][5][6][7].…”

mentioning

confidence: 99%

Procedural Sedation in Emergency Department: A Narrative Review

Cappellini,

Bavestrello Piccini,

Campagnola

et al. 2024

Emergency Care and Medicine

View full text Add to dashboard Cite

Procedural sedation and analgesia (PSA) in the emergency department (ED) presents a crucial aspect of emergency medicine, enabling the execution of painful or distressing procedures with minimal patient discomfort. This narrative review delineates the pharmacological framework, methodologies, and clinical considerations integral to optimizing PSA, with a particular focus on pediatric and geriatric populations. Through a comprehensive review and analysis of current practices, this work evaluates the pharmacokinetics and pharmacodynamics of widely utilized sedatives and analgesics, including propofol, ketamine, dexmedetomidine, fentanyl, midazolam, etomidate, nitrous oxide, and remimazolam. Special attention is dedicated to the selection criteria based on patient-specific risk factors, procedural requirements, and the management of potential adverse effects. The manuscript also explores innovative sedation techniques and the integration of new pharmacological agents, emphasizing evidence-based approaches to enhance patient safety and outcome. The results underscore the significance of tailored sedation strategies, especially for vulnerable groups such as pediatric and geriatric patients, highlighting the need for meticulous pre-procedural assessment and monitoring to mitigate risks. The conclusions drawn advocate for a nuanced application of PSA, guided by current evidence and clinical guidelines, to improve the quality of care in emergency settings. This research reinforces the imperative for ongoing education, skill development, and the adaptation of new evidence into clinical practice to advance procedural sedation and analgesia in the ED.

show abstract