Procedural sedation and analgesia for adults in the emergency department

摘要

A 59 year old woman presents to the emergency department with an isolated anterior dislocation of her left shoulder after a fall. Other than controlled asthma, she is healthy. Her last meal was four hours before the injury. After adequate analgesia using intravenous fentanyl, and despite an initial attempt to reduce her dislocation using relaxation techniques, it becomes evident that she needs sedation to complete the procedure successfully. What drugs are used for procedural sedation and analgesia? Patients in the emergency department often need to undergo painful, distressing, or unpleasant diagnostic and therapeutic procedures as part of their care. The use of various analgesic, sedative, and anaesthetic agents has been outlined in several well referenced guidelines. The American Society of Anesthesiologists (ASA) describes four levels of non-dissociative sedation-from minimal sedation to general anaesthesia-in addition to dissociative sedation (box). In practice, prolonged deep sedation or general anaesthesia is rarely used in the emergency department in the absence of a clinician with appropriate training in anaesthesia.