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

Abstract

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.

The Influence of Age on Propofol Dosing Requirements During Procedural Sedation in the Emergency Department

“…Although the noted incidence of these risks may not be uniformly distributed across all patient populations. Homfray, Palmer, Grimsmo-Powney, Appelboam, and Lloyd (2018) analyzed prospectively collected data on 740 elderly patients (older than 75 years) undergoing procedural sedation, 571 of whom received propofol. They identified a 2.6% sentinel adverse event rate and concluded that elderly patients are more susceptible to the adverse effects of all sedative drugs.…”

Incidence of adverse events for procedural sedation and analgesia for cardioversion using thiopental in elderly patients: a multicenter prospective observational study

“…3 Many elderly patients undergo ED‐based procedural sedation and analgesia (PSA) in the world. 4 , 5 In Japan, as in other countries, 56.6% of patients undergoing PSA were 65 years or older. 6 Elderly patients have increased sensitivity to sedatives.…”

Emergency department procedural sedation for the reduction of distal radial fractures: an observational cohort study

“…ED procedural sedation is frequently performed to enable DRF reduction but guidelines [2,4] are cautious in their recommendation, citing lack of safety data [6]. In 2012, an International Sedation Task Force of the World Society of Intravenous Anaesthesia (SIVA) published consensus guidance on the description and reporting terminology of procedural sedation adverse events , consequent interventions and clinical outcomes described with increasing severity, as minimal, minor, moderate and sentinel [7].…”

“…Displaced fractures often require a reduction in the ED to relieve neurovascular or soft tissue compromise or as definitive treatment [2,3]. National guidelines [2,4] for adult patients in the UK currently recommend intravenous regional anaesthesia (Bier's block) but management is far from standardised [2,4,5].ED procedural sedation is frequently performed to enable DRF reduction but guidelines [2,4] are cautious in their recommendation, citing lack of safety data [6]. In 2012, an International Sedation Task Force of the World Society of Intravenous Anaesthesia (SIVA) published consensus guidance on the description and reporting terminology of procedural sedation adverse events , consequent interventions and clinical outcomes described with increasing severity, as minimal, minor, moderate and sentinel [7].…”