Review of studies and guidelines on fasting and procedural sedation at the emergency department; a systematic review of the effectiveness of therapeutic interventions on quality of life (QoL) for adult vitiligo patients; effectiveness of educational interventions to raise men's awareness of bladder and bowel health; effectiveness of medical compared to multidisciplinary models of care for adult persons with pre-dialysis chronic kidney disease: a systematic review.

摘要

Procedural sedation and analgesia (PSA) refers to a technique of administering sedatives or dissociative agents with or without analgesics to induce a state that allows the patient to tolerate unpleasant procedures while maintaining cardio-respiratory function. Unlike deep sedation and general anaesthesia, PSA works by minimising the patient's awareness and discomfort, while allowing the patient to maintain spontaneous respiration and airway-protective reflexes. A potentially fatal complication associated with the administration of inhalational and intravenous anaesthetics in general is aspiration pneumonia. A predetermined fasting period before initiation of the procedure allows time for gastric contents to empty into the intestines, thus reducing the risk of regurgitation of stomach contents into the respiratory tract. However, patients in the emergency department undergoing urgent PSA are commonly not fasted on presentation or at the time of the procedure. The current clinical dilemma in the emergency department is deciding between immediately performing a critical procedure under PSA and delaying the procedure until the patient has been adequately fasted.