Emergency department procedural sedation: the London experience.

Aim: The aim of this study was to develop a procedural sedation guideline and an audit tool to identify the medications chosen, the incidence of predefined adverse events and the factors associated with their occurrence.

Methods: We performed a prospective observational study using a standardized proforma. We obtained data on patient demographics, the procedure performed, the drugs used and the dosages and predefined adverse events. Our target population was adult patients attending three urban UK teaching hospital Emergency Departments (EDs) over a 12-month period. We included all patients who were to undergo procedural sedation in the ED.

Results: Data were obtained on 414 patients. The majority of procedures were reductions of fractures and dislocations (89%). Midazolam was the sedative agent used most commonly (45%), and morphine was the most frequently used analgesic agent (36%). Overall 10% of sedations involved predefined complications (95% confidence interval: 7.1-12.9). There were no cases of airway obstruction requiring intervention; no patients showed clinical evidence of aspiration and no patient required intubation. Procedural success was 96%. Propofol was associated with fewer adverse events (95% confidence interval: 0.024-0.572), as well as higher procedural success.

Conclusion: Procedural sedation and analgesia can be safely and effectively performed in the ED by appropriately trained emergency physicians.