Procedural sedation and analgesia in a large UK Emergency Department: factors associated with complications

Jacques, Keith G; Dewar, Alistair; Gray, Alasdair; Kerslake, Dean; Leal, Alexis D.; Lees, F.

doi:10.1136/emj.2010.102475

Cited by 26 publications

(35 citation statements)

References 9 publications

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“…A successful closed reduction in the ED was achieved in 77.6% of all cases; which is in keeping with other reported data 2 4–7. A sedation-associated complication rate of 6.9% is in keeping with other studies, but is much higher than the 3.5% rate of any procedural complications reported by Jacques et al 3 in the same institution. This is possibly related to patients being sedated to a deeper level (sedation level 4–5) in 51% of hip sedation cases compared with 26% of all sedation cases.…”

Section: Discussionsupporting

confidence: 90%

“…We used the same standardised definition for complications as a result of sedation as defined by Jacques et al 3 who have previously reported 2 years data from the REPS dataset. These were any of systolic blood pressure less than 90 mm Hg, oxygen desaturation (<90%), apnoea, vomiting, aspiration, cardiac arrest or other events that were deemed complications by the operator.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Association between ASA grade and complication rate in patients receiving procedural sedation for relocation of dislocated hip prostheses in a UK emergency department

et al. 2013

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Section: Discussionsupporting

confidence: 90%

Section: Methodsmentioning

confidence: 99%

Association between ASA grade and complication rate in patients receiving procedural sedation for relocation of dislocated hip prostheses in a UK emergency department

et al. 2013

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“…The use of various analgesic, sedative, and anesthetic agents has been outlined in several guidelines . Numerous classes and combinations of drugs are commonly used for PSA in the ED . The use of short‐acting sedative agents such as propofol, etomidate, and ketamine, for example, has gained widespread acceptance.…”

mentioning

confidence: 99%

Incidence of Adverse Events in Adults Undergoing Procedural Sedation in the Emergency Department: A Systematic Review and Meta‐analysis

Bellolio

Gilani

Barrionuevo

et al. 2016

Academic Emergency Medicine

119

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ObjectivesThis was a systematic review and meta‐analysis to evaluate the incidence of adverse events in adults undergoing procedural sedation in the emergency department (ED).MethodsEight electronic databases were searched, including MEDLINE, EMBASE, EBSCO, CINAHL, CENTRAL, Cochrane Database of Systematic Reviews, Web of Science, and Scopus, from January 2005 through 2015. Randomized controlled trials and observational studies of adults undergoing procedural sedation in the ED that reported a priori selected outcomes and adverse events were included. Meta‐analysis was performed using a random‐effects model and reported as incidence rates with 95% confidence intervals (CIs).ResultsThe search yielded 2,046 titles for review. Fifty‐five articles were eligible, including 9,652 procedural sedations. The most common adverse event was hypoxia, with an incidence of 40.2 per 1,000 sedations (95% CI = 32.5 to 47.9), followed by vomiting with 16.4 per 1,000 sedations (95% CI = 9.7 to 23.0) and hypotension with 15.2 per 1,000 sedations (95% CI = 10.7 to 19.7). Severe adverse events requiring emergent medical intervention were rare, with one case of aspiration in 2,370 sedations (1.2 per 1,000), one case of laryngospasm in 883 sedations (4.2 per 1,000), and two intubations in 3,636 sedations (1.6 per 1,000). The incidence of agitation and vomiting were higher with ketamine (164.1 per 1,000 and 170.0 per 1,000, respectively). Apnea was more frequent with midazolam (51.4 per 1,000), and hypoxia was less frequent in patients who received ketamine/propofol compared to other combinations. The case of laryngospasm was in a patient who received ketamine, and the aspiration and intubations were in patients who received propofol. When propofol and ketamine are combined, the incidences of agitation, apnea, hypoxia, bradycardia, hypotension, and vomiting were lower compared to each medication separately.ConclusionsSerious adverse events during procedural sedation like laryngospasm, aspiration, and intubation are exceedingly rare. Quantitative risk estimates are provided to facilitate shared decision‐making, risk communication, and informed consent.

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“…5 In contrast, age was not a factor associated with complications in an analysis of 1402 adult patients in a Scottish ED. 6 As sedation is a common ED procedure, the UK population is ageing, and there is a perceived sedative risk in this patient group, we explored the safety of our service for the elderly in greater detail, irrespective of sedative agent used.…”

mentioning

confidence: 99%

Procedural sedation of elderly patients by emergency physicians: a safety analysis of 740 patients

Homfray

Palmer

Grimsmo-Powney

et al. 2018

British Journal of Anaesthesia

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Background: The elderly are perceived as a high-risk group for procedural sedation. Concern exists regarding the safety of sedation of this patient group by emergency physicians, particularly when using propofol. Methods: We analysed prospectively collected data on patients aged 75 yr or older undergoing sedation between October 2006 and March 2017 in the emergency department of a single centre. We used the World Society of Intravenous Anaesthesia International Sedation Task Force adverse event tool, stratifying identified adverse events according to consensus agreement. Results: Of 740 consecutive patients (median age 84 yr), 571 patients received propofol, 142 morphine and midazolam, and 27 other agents. We identified 19 sentinel events: 2 cases of hypoxaemia, 10 of apnoea (without hypoxaemia), 5 of hypotension, and 2 of both hypoxaemia and hypotension. We also identified 30 moderate, 41 minor, and 7 minimal risk adverse events. There were no adverse outcomes. Conclusions: We observed safe sedation practice in this high-risk group of patients. A sentinel adverse event rate of 2.6% including a hypoxaemia rate of 0.5% with no adverse outcomes sets a benchmark for sedation of the elderly.

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Procedural sedation and analgesia in a large UK Emergency Department: factors associated with complications

Cited by 26 publications

References 9 publications

Association between ASA grade and complication rate in patients receiving procedural sedation for relocation of dislocated hip prostheses in a UK emergency department

Association between ASA grade and complication rate in patients receiving procedural sedation for relocation of dislocated hip prostheses in a UK emergency department

Incidence of Adverse Events in Adults Undergoing Procedural Sedation in the Emergency Department: A Systematic Review and Meta‐analysis

Procedural sedation of elderly patients by emergency physicians: a safety analysis of 740 patients

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