Clinical Policy for Procedural Sedation and Analgesia in the Emergency Department

Mariani, Peter J.; Shepherd, Suzanne M.; Cantrill, Stephen V.; Campbell, Melody; Colucciello, Stephen A; Dalsey, William C.; Fesmire, Francis M.; Gallagher, E.John; Jagoda, Andy; Karas, Stephen; Murphy, Barbara A.; Pietrzak, Michael P; Sayers, Daniel G; Whitson, Rhonda R.

doi:10.1016/s0196-0644(98)70216-1

Cited by 160 publications

(11 citation statements)

References 32 publications

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“…Current guidelines from the American Academy of Pediatrics, American Society of Anesthesiologists, and American College of Emergency Physicians recommend a structured evaluation of children that allows risk stratification before beginning sedation, thereby reducing the risk of complications in the pediatric age group. 223,[227][228][229][230][231][232][233][234][235] This evaluation should include issues such as preexisting medical conditions, focused airway examination, and consideration of nil per os (NPO) status. NPO guidelines for children receiving sedation in the ED are controversial.…”

Section: Sedation Policies and Protocols In The Edmentioning

confidence: 99%

Relief of Pain and Anxiety in Pediatric Patients in Emergency Medical Systems

Zempsky¹,

Cravero²,

Shaw³

et al. 2012

Pediatrics

287

179

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Control of pain and stress for children is a vital component of emergency medical care. Timely administration of analgesia affects the entire emergency medical experience and can have a lasting effect on a child' s and family' s reaction to current and future medical care. A systematic approach to pain management and anxiolysis, including staff education and protocol development, can provide comfort to children in the emergency setting and improve staff and family satisfaction. Pediatrics 2012;130:e1391-e1405 BACKGROUND A systematic approach to pain management is required to ensure relief of pain and anxiety for children who enter into the emergency medical system, which includes all emergency medical services (EMS) agencies, interfacility critical care transport teams, and the emergency department (ED). 1 The administration of appropriate analgesia in children varies by age as well as by training of the ED team (which includes physicians, nurses, physician assistants, and nurse practitioners), however, and still lags behind analgesia provided for adults in similar situations. 2 Furthermore, neonates are at highest risk of receiving inadequate analgesia. 3,4 Encouragingly, improvements in the recognition and treatment of pain in children have led to changes in the approach to pain management for acutely ill and injured pediatric patients. 5 Studies have shown an increase in opiate use in children with fractures. [6][7][8] Recent advances in the approach and support for pediatric analgesia and sedation, as well as new products and devices, have improved the overall climate of the ED for patients and families in search of the "ouchless" ED. 5,9 Increased parental education regarding pain and sedation, physician comfort and desire to enhance patient satisfaction, and a quest to satisfy accreditation regulations have appropriately driven this effort. System-wide approaches for pain management awareness and strategies work best if they are woven into the fabric of the emergency medical system through education and protocol development. The purpose of this report was to provide information to optimize the comfort and minimize the distress of children and families as they are cared for in the emergency setting.

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Section: Sedation Policies and Protocols In The Edmentioning

confidence: 99%

Relief of Pain and Anxiety in Pediatric Patients in Emergency Medical Systems

Zempsky¹,

Cravero²,

Shaw³

et al. 2012

Pediatrics

287

179

View full text Add to dashboard Cite

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“…The IV combination of ketamine and propofol allows drug dosing that is less than that used with either propofol or ketamine as a sole agent and has gained a degree of interest for emergency department PSA patients. [ 32 ]…”

Section: Discussionmentioning

confidence: 99%

Ketamine versus Ketamine / magnesium Sulfate for Procedural Sedation and Analgesia in the Emergency Department: A Randomized Clinical Trial

et al. 2018

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Background:The present study was designed to evaluate the effectiveness of magnesium sulfate (MgSO4) in procedural sedation and analgesia (PSA) when combined with ketamine in patients with fractures in emergency departments and required short and painful emergency procedures.Materials and Methods:In this study, 100 patients with fractures and dislocations who were presented to the emergency departments and required PSA for short and painful emergency procedures were randomly allocated to groups of ketamine plus MgSO4 or ketamine alone. Train of four (TOF) stimulation pattern was assessed using nerve stimulator machine and compared between groups.Results:The mean age of studied patients was 46.9 ± 9.3 years old. 48% were male and 52% were female. No significant differences were noted between groups in demographic variables. The status of TOF, 2 min after the injection of ketamine (1.5 mg/kg), in both groups was similar. After the injection of the second dose of ketamine (1 mg/kg) the status of TOF in four patients in ketamine plus MgSO4 (0.45 mg/kg) group changed, it was three quarters but in ketamine group, the status of TOF in all patients was four quarters. The difference between groups was not statistically significant (P = 0.12).Conclusion:The findings revealed that for muscle relaxation during medical procedures in the emergency department, ketamine in combination with MgSO4 with this dose was not effective for muscle relaxation during procedures.

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“…Fentanyl is the opioid most commonly used for analgesia during procedural sedation in the ED. 3 , 4 When given intravenously, analgesia can commence in 90 seconds. 5 The clinical effects of fentanyl in the acute setting last for approximately 30 minutes.…”

Section: Discussionmentioning

confidence: 99%