Procedural Sedation and Analgesia in the Emergency Department
Publication Date: October 1, 2013
Last Updated: March 14, 2022
Recommendations
Do not delay procedural sedation in adults or pediatrics in the ED based on fasting time. Preprocedural fasting for any duration has not demonstrated a reduction in the risk of emesis or aspiration when administering procedural sedation and analgesia. (B)
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Capnography may be used as an adjunct to pulse oximetry and clinical assessment to detect hypoventilation and apnea earlier than pulse oximetry and/or clinical assessment alone in patients undergoing procedural sedation and analgesia in the ED. (B)
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During procedural sedation and analgesia, a nurse or other qualified individual should be present for continuous monitoring of the patient, in addition to the provider performing the procedure. Physicians who are working or consulting in the ED should coordinate procedures requiring procedural sedation and analgesia with the ED staff. (C)
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Ketamine can be safely administered to children for procedural sedation and analgesia in the ED. Propofol can be safely administered to children and adults for procedural sedation and analgesia in the ED. (A)
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Etomidate can be safely administered to adults for procedural sedation and analgesia in the ED. A combination of propofol and ketamine can be safely administered to children and adults for procedural sedation and analgesia. (B)
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Ketamine can be safely administered to adults for procedural sedation and analgesia in the ED. Alfentanil can be safely administered to adults for procedural sedation and analgesia in the ED. Etomidate can be safely administered to children for procedural sedation and analgesia in the ED. (C)
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Title
Procedural Sedation and Analgesia in the Emergency Department
Authoring Organization
American College of Emergency Physicians
Publication Month/Year
October 1, 2013
Last Updated Month/Year
September 13, 2023
External Publication Status
Published
Country of Publication
US
Document Objectives
Critical questions relevant to the current practice of emergency medicine were developed for this revision, which addresses critical questions in addition to offering a summary of recent concepts, agents, and developments in procedural sedation and analgesia
Target Patient Population
Patients with emergent and urgent conditions that require procedural sedation with or without analgesia in the emergency department (ED)
Inclusion Criteria
Female, Male, Adolescent, Adult, Child, Older adult
Health Care Settings
Emergency care
Intended Users
Paramedic emt, nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Management
Diseases/Conditions (MeSH)
D000698 - Analgesia, D000700 - Analgesics, D054810 - Deep Sedation, D016292 - Conscious Sedation
Keywords
sedation, analgesia, procedural sedation
Source Citation
Ann Emerg Med. 2014;63:247-258.
Methodology
Number of Source Documents
97
Literature Search Start Date
January 1, 2004
Literature Search End Date
May 1, 2012