Sedation practice in a Scottish teaching hospital emergency department

“…Notwithstanding these factors, it is noted that the reported complication rate in this study is similar to previously reported series,5 suggesting that the figures presented are robust.…”

Section: Resultssupporting

confidence: 90%

“…Case series of PSA in the general or adult ED setting from the UK5 6 have reported complication rates of 1–16%, with variation depending on setting, agents and definition of adverse events. Although low complication rates and associated adverse outcomes may be reassuring, they present a challenge to research.…”

Section: Introductionmentioning

confidence: 99%

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

Jacques

Dewar

Gray

et al. 2010

“…The ACEP clinical policy document lists respiratory depression as the most concerning of adverse events,2 which may also include loss of a patent airway, hypotension, agitation, bradycardia, vomiting and myoclonia 3 – 7. Fortunately, adverse events tend to be transient, mainly occur during the procedure and rarely affect patient disposition 4 5 7 8. The British National Formulary warns that extraneous muscle movements, cardiovascular stimulation with tachycardia and hypertension, hallucinations, nightmares and other transient psychotic effects may specifically occur with ketamine 1…”

Section: Studies Comparing the Incidence Of Adverse Event With Different Sedation Agentsmentioning

confidence: 99%

“…Available information suggests a recovery time to full orientation for ketamine which is similar to midazolam and longer than for propofol 4 9 – 11. Recall of the procedure is thought to be uncommon and its absence important for patient satisfaction, however some patients with recall will still be perfectly satisfied with their procedure 12 13…”

Section: Recovery Recall and Re-emergence Phenomenonmentioning

confidence: 99%

Audit of the safety and effectiveness of ketamine for procedural sedation in the emergency department

Vardy

Dignon

Mukherjee

et al. 2008

Aim: To examine the effectiveness and safety of the sedative agents used in the emergency department following the introduction of ketamine as an agent for procedural sedation Methods: A 2-year prospective audit of sedation practice was undertaken. This specifically examined the rationale behind a doctor's choice of sedative agent, the depth of sedation achieved, adverse events and the time taken to regain full orientation. Results: 210 patients were included of whom 85 (40%) were given ketamine, 107 (51%) midazolam and 18 (9%) propofol. The median time to full orientation was 25 min for ketamine, 30 min for midazolam and 10 min for propofol. Complications occurred in 15.9% of sedations overall (14.6% of those given ketamine, 15.8% given midazolam and 22.2% given propofol). Apnoea and hypoxia most often occurred with midazolam and propofol, while hypertension and hypertonicity were encountered more frequently with ketamine. In addition, 19.5% of patients given ketamine suffered the reemergence phenomenon. The association between deep sedation with no response to pain and adverse events encountered with midazolam does not occur with ketamine. Conclusions: Ketamine is both safe and effective and compares favourably with midazolam as an agent for procedural sedation in the emergency department. Although the re-emergence phenomenon occurred, no psychological sequelae were encountered after return to full orientation. Ketamine may be particularly useful in groups of patients at high risk of adverse effects with midazolam.Ketamine produces a dissociative state and provides good analgesia at a subanaesthetic dosage.

“…Nitrous oxide was not reported as an agent used; as the actual survey was not included it is not clear if nitrous oxide was not used in EDs or questions about nitrous oxide had not been included in the survey. In a Scottish ED report20 entonox use was reported as a procedural agent but most sedations were in adults and sedation agents were not reported by patient age. In Australia and New Zealand, data from two surveys of sedation practice in paediatric EDs22 23 indicated that nitrous oxide was the most frequently used procedural agent; the most recent survey indicated that all departments surveyed used nitrous oxide and ketamine 22.…”

Section: Discussionmentioning

confidence: 99%

Paediatric procedural sedation based on nitrous oxide and ketamine: sedation registry data from Australia

Babl

Belousoff

Deasy

et al. 2010