Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department

Godwin, Steven A.; Burton, John H.; Gerardo, Charles J.; Hatten, Benjamin W.; Mace, Sharon E.; Silvers, Scott M.; Fesmire, Francis M.

doi:10.1016/j.annemergmed.2013.10.015

Cited by 436 publications

(150 citation statements)

References 87 publications

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“…Capnometry requires a nasal cannula or a face mask that may be unpleasant or can be removed by patients. Occasionally, hypoventilation may paradoxically cause the end-tidal CO 2 (EtCO 2 ) to decrease because of the inadequate mixing of alveolar gas [6,7]. Therefore, a new more reliable continuous RR monitoring device is needed.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for bradypnea in a historical cohort of surgical patients receiving fentanyl-based intravenous analgesia

et al. 2018

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Introduction: The use of both pulse oximetry (SpO 2 ) and respiration rate (RR) monitoring is recommended to prevent the development of respiratory deterioration, particularly after extubation and narcotic analgesic use for pain management. In this study, we investigated the factors contributing to the development of bradypnea in surgical patients receiving fentanyl-based intravenous analgesia after general anesthesia. Methods: This study involved a historical chart review of postoperative patients outside an intensive care unit setting. We divided the patients according to the data collected during the first hour postoperatively, into those developing bradypnea (RR < 8 breaths per min for > 2 min) and those with normal RR under oxygen administration. We defined oxygen desaturation as SpO 2 < 90% for > 10 s. We calculated the effect-site concentrations for fentanyl at the end of surgery and 1 h postoperatively using custom-made software based on chart records. A multivariable analysis was used to determine bradypnea-associated explanatory factors. Results: For the final analysis, we included 258 patients. We detected bradypnea in 125 patients (48%) and oxygen desaturation in 46 patients (18%). We found no difference in the effect-site fentanyl concentrations between patients with and without bradypnea. The logistic regression model revealed that liver dysfunction [odds ratio (OR), 2.918; 95% confidence interval (CI), 1.329-6.405], renal dysfunction (OR, 0.349; 95% CI, 0.128-0.955), and smoking history (OR, 0.236; 95% CI, 0.075-0.735) were independently associated with bradypnea. We found similar incidences of oxygen desaturation between the groups. Conclusions: Bradypnea was observed in 48% of postoperative patients receiving fentanyl-based intravenous analgesia under oxygen therapy. According to our results, impaired liver function associated positively, whereas smoking history associated negatively with its development. Renal dysfunction was paradoxically associated with less incidence of bradypnea.

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Section: Introductionmentioning

confidence: 99%

Risk factors for bradypnea in a historical cohort of surgical patients receiving fentanyl-based intravenous analgesia

et al. 2018

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“…Despite the increase in the last few years in the number and complexity of such outpatient procedures, there is limited scientific data and no guidelines to help describe safe, optimal sedation. The few scientific publications on procedural sedation address such things as standardization of processes and reasons for sedation [1][2][3][4][5]. Given the frequency and importance of these procedures in terms of the comfort and well-being of patients, we have decided to review the literature with the goal of establishing the reason(s) that "appropriate" guidelines have thus far not been issued.…”

Section: Introductionmentioning

confidence: 99%

Role Of Anaesthetist In Sedation For Diagnostic Procedures: The Glass Is Half Empty? A Narrative Review

Pasqualucci¹,

Nadhari²,

Vaidyan³

et al. 2017

SOJAPM

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Sedation of outpatients undergoing diagnostic and therapeutic procedures remains a controversial topic, and there remains a paucity of literature and guidelines to help inform sound clinical decisions. As these are frequently performed procedures that offer advantages to patients in terms of their comfort and well-being, we aimed to better address this information deficit and to clarify why appropriate guidelines are still not available. To this end, we propose reviewing sedation procedures performed using Magnetic Resonance Imaging (MRI) in pediatric patients.

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“…PSA is the administration of sedatives to induce a depressed level of consciousness while maintaining cardio respiratory functions. This is done so that a medical procedure can be done (Godwin et al 2005). (Ramoska et al 1991).…”

Section: Introductionmentioning

confidence: 99%

“…Among issues that is different to normal outpatient clinic is the occurrence which is unpredictable, the timing is time dependent and sometimes emergent, gastric state is variable (either fasted or not). Patients are unselected and may have underlying systemic disease (Godwin et al 2005). Hence, even though the adverse effects of midazolam was extensively studied in various clinical locations, the data for midazolam use in ED especially throughout Malaysia, is still lacking.…”

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confidence: 99%

Adverse Drug Reaction with Midazolam Use in Emergency Department

Muhamad¹

2016

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ABSTRAK Midazolam adalah salah satu ubat yang paling biasa digunakan sebagai ubat pelali di Jabatan Kecemasan (ED). Ini adalah satu kajian retrospektif yang dijalankan ke atas 380 pesakit dari Disember 2012 hingga Mei 2014 di ED, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM). ABSTRACTMidazolam is one of the most commonly used drugs for sedation in Emergency Department (ED). This was a retrospective study conducted on 380 patients from 3 Med & Health 2016;11(1): 2-10 Procedural sedation is commonly used for outpatient medical procedures and done by non-anesthesiology physicians (Knape et al. 2007). The use of midazolam in the ED is unique in terms that the location possess different issues and risks to the physician. Among issues that is different to normal outpatient clinic is the occurrence which is unpredictable, the timing is time dependent and sometimes emergent, gastric state is variable (either fasted or not). Patients are unselected and may have underlying systemic disease (Godwin et al. 2005). Hence, even though the adverse effects of midazolam was extensively studied in various clinical locations, the data for midazolam use in ED especially throughout Malaysia, is still lacking. Midazolam Use in Emergency DepartmentAdverse reactions from midazolam use include urinary retention, nausea, vomiting and excessive somnolence December 2012 to May 2014 in ED of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). The objective was to elicit the frequency of side effects and correlation to various factors i.e. socio-demography, co-morbidities, age groups and underlying illnesses. Out of 380 patients, 35 patients experienced side effects (20 patients with midazolam alone, 15 patients with combination of drugs). The average age was 42 years and the average dose of midazolam was 3.5mg. The most common other drug combined was fentanyl. The overall complication rate for midazolam was 5.3%. The most common side effect recorded was excessive somnolence (1.6%). Other side effects included local skin reactions (1.1%), vomiting (0.8%), headache (0.8%) and hypotension (0.5%). There was no significant association between the socio-demographic factors and drugs combination with the side effects of midazolam on patients. It was concluded that midazolam was a safe drug due to absence of any life-threatening side effects. There are possibilities that most side effects recorded could be caused by other comfounding factors e.g. underlying injuries or disease and combination with other drugs.

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Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department

Cited by 436 publications

References 87 publications

Risk factors for bradypnea in a historical cohort of surgical patients receiving fentanyl-based intravenous analgesia

Risk factors for bradypnea in a historical cohort of surgical patients receiving fentanyl-based intravenous analgesia

Role Of Anaesthetist In Sedation For Diagnostic Procedures: The Glass Is Half Empty? A Narrative Review

Adverse Drug Reaction with Midazolam Use in Emergency Department

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