Alan J Smally1, Thomas Anthony Nowicki. 1. University of Connecticut Division of Emergency Medicine, Hartford Hospital, Hartford, CT 06102, USA. asmally@harthosp.org
Abstract
PURPOSE OF REVIEW: The recent year's literature is reviewed concerning the use of sedation in the emergency department. The use of moderate to deep sedation is becoming common in emergency medicine for many reasons, including progressive hospital crowding, limited availability of anesthesia, and increased training in residency. This is performed for a wide variety of procedures, most commonly orthopedic. RECENT FINDINGS: The literature discussed medications, monitoring, and the safety of current sedation practice in the emergency department. Emergency department procedural sedation and analgesia is performed with a number of medications, including propofol, etomidate, midazolam, fentanyl, ketamine, and nitrous oxide. Cardiac monitoring, pulse oximetry and capnography are used, often without strong evidence-based support of need. Complications do occur and are higher in prospective studies than in retrospective series. This suggests a degree of underreporting. Nevertheless, clinically important complications are uncommon. SUMMARY: The year's literature reflects the reality that the performance of sedation in the emergency department is advantageous. As the era of evidence-based medicine continues to provide us with more and better information, the combined efforts of both anesthesiology and emergency medicine can hopefully contribute to improving patient safety with respect to procedural sedation.
PURPOSE OF REVIEW: The recent year's literature is reviewed concerning the use of sedation in the emergency department. The use of moderate to deep sedation is becoming common in emergency medicine for many reasons, including progressive hospital crowding, limited availability of anesthesia, and increased training in residency. This is performed for a wide variety of procedures, most commonly orthopedic. RECENT FINDINGS: The literature discussed medications, monitoring, and the safety of current sedation practice in the emergency department. Emergency department procedural sedation and analgesia is performed with a number of medications, including propofol, etomidate, midazolam, fentanyl, ketamine, and nitrous oxide. Cardiac monitoring, pulse oximetry and capnography are used, often without strong evidence-based support of need. Complications do occur and are higher in prospective studies than in retrospective series. This suggests a degree of underreporting. Nevertheless, clinically important complications are uncommon. SUMMARY: The year's literature reflects the reality that the performance of sedation in the emergency department is advantageous. As the era of evidence-based medicine continues to provide us with more and better information, the combined efforts of both anesthesiology and emergency medicine can hopefully contribute to improving patient safety with respect to procedural sedation.