Unscheduled Procedural Sedation: A Multidisciplinary Consensus Practice Guideline

Abstract

(ACEP) organized a multidisciplinary effort to create a clinical practice guideline specific to unscheduled, time-sensitive procedural sedation, which differs in important ways from scheduled, elective procedural sedation. The purpose of this guideline is to serve as a resource for practitioners who perform unscheduled procedural sedation regardless of location or patient age. This document outlines the underlying background and rationale, and issues relating to staffing, practice, and quality improvement. [

Is the Mallampati Score Useful for Emergency Department Airway Management or Procedural Sedation?

“…22,[44][45][46] In their most recent procedural sedation policy, the American College of Emergency Physicians (ACEP) concluded that "[t]here is no evidence that the addition of the Mallampati score to a standard general evaluation of the anatomic or physiologic variants.has any impact on clinical outcomes during sedation, and thus it cannot be recommended." 61 In conclusion, the literature evidence demonstrates that the Mallampati score is inadequately sensitive for the identification of difficult laryngoscopy, difficult intubation, and difficult bag-valve-mask ventilation, with likelihood ratios indicating a small and clinically insignificant effect on outcome prediction. Although it is important to anticipate that patients may have a difficult airway, there is no specific evidence that the Mallampati score augments or improves the baseline clinical judgment of a standard airway evaluation.…”

Experiencia en sedoanalgesia vinculada a procedimientos en un departamento de emergencia pediátrica

“…2011-2016. sucesivas, comprendidas en el límite superior, para lograr el efecto deseado. Comenzar con dosis bajas titulando las mismas, respetando el tiempo de inicio de acción hasta lograr al efecto deseado y utilizar escalas de sedación y analgesia, es lo recomendado para alcanzar el objetivo terapéutico con un menor riesgo de efectos adversos (13)(14)(15)(16) . Contar con protocolos para procedimientos de sedoanalgesia en los departamentos de emergencia y personal entrenado es esencial para brindar una mejor asistencia al paciente y su familia desde la institución, constituyendo uno de los estándares de calidad (10,(14)(15)(16)(17) .…”

“…Uno de los aspectos más importantes para garantizar la seguridad del paciente, sobre todo en los casos que se administran fármacos por vía endovenosa, es realizar una planificación previa que incluye la evaluación del candidato a la sedoanalgesia. La adecuada monitorización durante la realización de los procedimientos para pesquisar precozmente los efectos adversos, como se realizó en esta cohorte, y contar con recursos humanos capacitados para conocer y manejar las posibles complicaciones es fundamental cuando se implementa este tipo de procedimientos en un servicio (14)(15)(16)(17)(18) .…”

A mini‐review of procedural sedation and analgesia in the emergency department

“…2,6 As a result, emergency medicine societies in some countries have published different policy statements and guidelines specific to the ED practices in their respective countries. 1,7,8 The European Society of Anesthesiology and European Board of Anesthesiology also published PSA guidelines for adults. 9 In Japan, the context for PSA differs from that in North America and Europe in three primary ways.…”

“…EPs must manage not just the procedure and PSA, but also the acute pain, anxiety, unstable physiological state, undefined diagnosis, insufficient patient information, and associated troubles. 8 The Japan Society of Procedural Sedation and Analgesia (JSPSA) developed a PSA training course in order to meet the need for training in Japan and other countries in Asia. The course evaluation results showed that health care professionals who participated in the training had a somewhat limited baseline knowledge of pharmacology, elderly patients, timing of AEs, and fasting time on PSA, and that the knowledge was significantly improved after the training.…”