Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-21T11:35:05.887Z Has data issue: false hasContentIssue false
  • English
  • Français

Emergency department procedural sedation and analgesia: A Canadian Community Effectiveness and Safety Study (ACCESS)

Published online by Cambridge University Press:  21 May 2015

Mark Mensour ,
Robert Pineau ,
Vic Sahai  and
Jennifer Michaud
Mark Mensour*
Affiliation:
Department of Emergency Medicine, Northern Ontario School of Medicine, East Campus, Sudbury, Ont.; Resident Evaluation Coordinator, Northeastern Ontario Family Medicine Program; Emergency Medicine and Anesthesia, Huntsville District Memorial Hospital, Huntsville, Ont.
Robert Pineau
Affiliation:
Resident in Family Medicine, Emergency Medicine Program, Northeastern Ontario Family Medicine Program
Vic Sahai
Affiliation:
Northern Health Information Partnership, Northeastern Ontario Medical Education Corporation; Health Informatics, Northern Ontario School of Medicine, East Campus, Sudbury, Ont.
Jennifer Michaud
Affiliation:
Northeastern Ontario Medical Education Corporation
*
Muskoka East-Perry Sound Health Services, Huntsville District Memorial Hospital, 100 Frank Miller Dr., Huntsville ON P1H 1H7; mensours@cogeco.ca

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objectives:

To determine the effectiveness and safety of procedural sedation and analgesia (PSA) in a Canadian community emergency department (ED) staffed primarily by family physicians and to assess the role of capnometry monitoring in PSA.

Methods:

One hundred and sixty (160) consecutive procedural sedation cases were reviewed from the ED of a rural hospital in Huntsville, Ont. The ED is mainly staffed by family physicians who have received in-house training in PSA. Safety and effectiveness measures were extrapolated from a standardized PSA form by a blinded research assistant.

Results:

The mean age of the patient population was 33.6 years (standard deviation = 23.6). Fifty-four percent of the patients were male, and 33% of the cases were pediatric. PSA medications included propofol (84%), fentanyl (51%) and midazolam (15%), and the procedural success rate was 95.6%. The adverse event (AE) rate was 18% and included apnea (10%), inadequate sedation (3%), bradycardia (2%), desaturation (1%), hypotension (1%) and bag-valve-mask use (1%). In those aged ≥65 years there was a greater incidence of apnea. There were no episodes of emesis and there were no intubations. A modified jaw thrust manoeuvre was used in 23% of the cases. In the 64% of cases where capnometry was used, there was no association between its use and any AE measures.

Conclusion:

Procedural sedation was safe and effective in our environment. Capnometry recording did not appear to alter outcomes, although the data are incomplete.

Keywords

emergency department, ruralemergency department, communityfamily physiciansgeneral practitionerssafety effectivenesscapnometryprocedural sedation and analgesia
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 8 , Issue 2 , March 2006 , pp. 94 - 99
Copyright
Copyright © Canadian Association of Emergency Physicians 2006

References

1.Miner, JR, Biros, M, Krieg, S, et al. Randomized clinical trial of propofol versus methohexital for procedural sedation during fracture and dislocation reduction in the emergency department. Acad Emerg Med 2003;10:931–7.Google Scholar
2.Reid, DK, Mensour, M.The use of propofol for procedural sedation in a rural community hospital [abstract]. Can J Emerg Med 2004;6(3):208.Google Scholar
3.Innes, G, Murphy, M, Nijssen-Jordon, C, et al. Procedural sedation and analgesia in the emergency department. Canadian Consensus Guideines. J Emerg Med 1999;17:145–56.CrossRefGoogle Scholar
4.Guenther, E, Pribble, CG, Junkins, EP, et al. Propofol sedation by emergency physicians for elective pediatric outpatient procedures. Ann Emerg Med 2003;42:783–91.Google Scholar
5.Coll-Vinent, B, Sala, X, Fernandez, C, et al. Sedation for cardioversion in the emergency department: analysis of effectiveness in four protocols. Ann Emerg Med 2003;42:767–72.Google Scholar
6.Bassett, KE, Anderson, JL, Pribble, CG, et al. Propofol for procedural sedation in children in the emergency department. Ann Emerg Med 2003;42:773–82.CrossRefGoogle ScholarPubMed
7.Mace, SE, Barata, IA, Cravero, JP, et al. Clinical policy: evidence-based approach to pharmacologic agents ssed in pediatric sedation and analgesia in the emergency department. Ann Emerg Med 2004;44:342–77.Google Scholar
8.Godwin, SA, Caro, DA, Wolf, SJ, et al. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med 2005;45:177–96.Google Scholar
9.Godambe, SA, Elliot, V, Matheny, D, et al. Comparison of propofol/ fentanyl versus ketamine/midazolam for brief orthopedic procedural sedation in a pediatric emergency department. Pediatrics 2003;112:116–23.Google Scholar
10.Pershad, J, Godambe, SA.Propofol for procedural sedation in the pediatric emergency department. J Emerg Med 2004;27:11–4.CrossRefGoogle ScholarPubMed
11.Skokan, EG, Pribble, C, Bassett, KE, et al. Use of propofol sedation in a pediatric emergency department: a prospective study. Clin Pediatr (Phila) 2001;40:663–71.Google Scholar
12.Havel, CJ Jr, Strait, RT, Hennes, H.A clinical trial of propofol vs. midazolam for procedural sedation in a pediatric emergency department. Acad Emerg Med 1999;6:989–97.Google Scholar
13.Frazee, BW, Park, RS, Lowery, D, et al. Propofol for deep procedural sedation in the emergency department. Am J Emerg Med 2005;23:190–5.Google Scholar
14.Reeves, ST, Havidich, JE, Tobin, DP.Conscious sedation of children with propofol is anything but conscious [electronic article]. Pediatrics 2004;114:e74–6.Google Scholar
15.Miner, JR, Martel, ML, Meyer, M, et al. Procedural sedation of critically ill patients in the emergency department. Acad Emerg Med 2005;12:124–8.CrossRefGoogle ScholarPubMed
16.Swanson, ER, Seaberg, DC, Mathias, S.The use of propofol for sedation in the emergency department. Acad Emerg Med 1996;3:234–8.Google Scholar
17.Green, SM, Krauss, B.Propofol in emergency medicine: pushing the sedation frontier. Ann Emerg Med 2003;42:792–7.Google Scholar
18.Barbi, E, Gerarduzzi, T, Marchetti, F, et al. Deep sedation with propofol by nonanesthesiologists. Arch Pediatr Adolesc Med 2003;157:1097–103.Google Scholar
19.Pitetti, RD, Singh, S, Clyde Pierce, M.Safe and efficacious use of procedural sedation and analgesia by nonanesthesiologists in a pediatric emergency department. Arch Pediatr Adolesc Med 2003;157:1090–6.Google Scholar
20.Brown, TB, Lovato, LM, Parker, D.Procedural sedation in the acute care setting. Am Fam Physician 2005;71:85–90.Google Scholar
21.Vardi, A, Salem, Y, Padeh, S, et al. Is propofol safe for procedural sedation in children? A prospective evaluation of propofol versus ketamine in pediatric critical care. Crit Care Med 2002;30:1231–6.Google Scholar
22.Kapklein, MJ, Slonim, AD.Ketamine vs. propofol: How safe is safe enough? Crit Care Med 2002;30:1384–6.Google Scholar
23.Cray, SH, Pettifer, RJ.Sedation in pediatric patient [letter]. Crit Care Med 2003;31:1599.Google Scholar
24.McQuillen, K, Steele, D.Capnography during sedation/analgesia in the pediatric emergency department. Pediatr Emerg Care 2000;16:401–4.Google Scholar
25.Miner, JR, Heegaard, W, Plummer, D.End-tidal carbon dioxide monitoring during procedural sedation. Acad Emerg Med 2002;9:275–80.Google Scholar
26.Beveridge, R, Clarke, B, Janes, L, et al. Canadian Emergency Department Triage and Acuity Scale: implementation guidelines. Can J Emerg Med 1999;1(3 suppl). Online version available at: www.caep.ca/002.policies/002-02.ctas.htm (accessed 23 Jan 2006).Google Scholar
27.Litman, RS.Propofol and pediatric sedation [letter]. Ann Emerg Med 2004;44:184.CrossRefGoogle ScholarPubMed
28.Block, AJ, Boysen, PG, Wynne, JW, et al. Sleep apnea hypopnea and oxygen desaturation in normal subjects: a strong male predominance. N Engl J Med 1979;300:513–7.CrossRefGoogle ScholarPubMed
29.Ducharme, J.Propofol in the emergency department: another interpretation of the evidence [editorial]. Can J Emerg Med 2001;3(4):311–2.CrossRefGoogle ScholarPubMed
30.Burton, JH, Miner, JR, Shipley, ER, et al. Propofol for emergency department procedural sedation and analgesia: a tale of three centers. Acad Emerg Med 2006;13:24–30.CrossRefGoogle ScholarPubMed
31.Evered, L, Klassan, TP, Hartling, L, et al. Options for procedural sedation in paediatric patients requiring painful or anxiety provoking procedures outside the operating room. The Cochrane Library 2005;2:2–6.Google Scholar