Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department

Annals of Emergency Medicine

Volumn 63, Issue 2, 2014, Pages 247-258.e18

  Godwin, Steven A ^a   Burton, John H ^a   Gerardo, Charles J ^a   Hatten, Benjamin W ^a   MacE, Sharon E ^a   Silvers, Scott M ^a   Fesmire, Francis M ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ALFENTANIL; DEXMEDETOMIDINE; ETOMIDATE; KETAMINE; PROPOFOL; REMIFENTANIL; PIPERIDINE DERIVATIVE;

ANALGESIA; ARTICLE; ASPIRATION; CAPNOMETRY; CLINICAL PROTOCOL; COMPRESSION; CONSCIOUS SEDATION; DEEP SEDATION; EMERGENCY MEDICINE; EMERGENCY PHYSICIAN; EMERGENCY WARD; EVIDENCE BASED PRACTICE; HIGH RISK PATIENT; PATIENT MONITORING; PRIORITY JOURNAL; PROTOCOL COMPLIANCE; RANDOMIZED CONTROLLED TRIAL (TOPIC); RISK REDUCTION; SEDATION; VOMITING; EMERGENCY HEALTH SERVICE; GENERAL ANESTHESIA; HUMAN; MANPOWER; PRACTICE GUIDELINE; REVIEW; STANDARD;

ALFENTANIL; ANALGESIA; ANESTHESIA, GENERAL; CAPNOGRAPHY; CONSCIOUS SEDATION; DEEP SEDATION; DEXMEDETOMIDINE; EMERGENCY SERVICE, HOSPITAL; ETOMIDATE; HUMANS; KETAMINE; PIPERIDINES; PROPOFOL;

EID: 84897574689     PISSN: 01960644     EISSN: 10976760     Source Type: Journal    
DOI: 10.1016/j.annemergmed.2013.10.015     Document Type: Review

References (97)

1. S.A. Godwin, D.A. Caro, S.J. Wolf et al. American College of Emergency Physicians. ACEP clinical policy: procedural sedation and analgesia in the emergency department Ann Emerg Med 45 2005 177 196
2. D.G. Perina, P. Brunett, D.A. Caro et al. 2011 EM Model Review Task Force. The 2011 model of the clinical practice of emergency medicine Acad Emerg Med 19 2012 e19 e40
3. Accreditation Council for Graduate Medical Education. ACGME program requirements for graduate medical education in emergency medicine and pediatric emergency medicine. July 1, 2007. Available at: http://www.acgme.org/acgmeweb/tabid/131/ProgramandInstitutionalGuidelines/Hospital-BasedAccreditation/EmergencyMedicine.aspx. Accessed November 9, 2012.
4. American Osteopathic Association and American College of Osteopathic Emergency Physicians. Basic standards for residency training in emergency medicine. July 2011. Available at: http://www.osteopathic.org/inside-aoa/accreditation/postdoctoral-training-approval/postdoctoral-training-standards/Documents/basic-standards-for-residency-training-in-emergency-medicine.pdf. Accessed November 9, 2012.
5. Centers for Medicare & Medicaid Services (CMS). Revised appendix A, interpretive guidelines for hospitals - state operations manual, anesthesia services. Effective December 2, 2011. Available at: http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R74SOMA.pdf. Accessed: November 9, 2012.
6. The Joint Commission Hospital Accreditation Standards 2013 TJC Publication Oakbrook Terrace, IL
7. American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists Practice guidelines for sedation and analgesia by non-anesthesiologists Anesthesiology 96 2002 1004 1017
8. C.J. Cote, S. Wilson American Academy of Pediatrics, American Academy of Pediatric Dentistry, Work Group on Sedation. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update Pediatrics 118 2006 2587 2602
9. Centers for Medicare & Medicaid Services (CMS). FAQs for revisions to anesthesia services interpretive guidelines. CMS letter to State Survey Agency Directors, January 14, 2011.
10. American Society of Anesthesiologists. Continuum of depth of sedation: definition of general anesthesia and levels of sedation/analgesia. October 21, 2009. Available at: http://www.asahq.org/Home/For-Members/Clinical-Information/Standards-Guidelines-and-Statements. Accessed: November 9, 2012.
11. S.M. Green, M.G. Roback, R.M. Kennedy et al. Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update Ann Emerg Med 57 2011 449 461
12. E.V. Willman, G. Andolfatto A prospective evaluation of "ketofol" (ketamine/propofol combination) for procedural sedation and analgesia in the emergency department Ann Emerg Med 49 2007 23 30
13. G. Andolfatto, E. Willman A prospective case series of pediatric procedural sedation and analgesia in the emergency department using single-syringe ketamine-propofol combination (ketofol) Acad Emerg Med 17 2010 194 201
14. G. Andolfatto, E. Willman A prospective case series of single-syringe ketamine-propofol (ketofol) for emergency department procedural sedation and analgesia in adults Acad Emerg Med 18 2011 237 245
15. H. David, J. Shipp A randomized controlled trial of ketamine/propofol versus propofol alone for emergency department procedural sedation Ann Emerg Med 57 2011 435 441
16. A. Shah, G. Mosdossy, S. McLeod et al. A blinded, randomized controlled trial to evaluate ketamine/propofol versus ketamine alone for procedural sedation in children Ann Emerg Med 57 2011 425 433
17. D.W. Messenger, H.E. Murray, P.E. Dungey et al. Subdissociative-dose ketamine versus fentanyl for analgesia during propofol procedural sedation: a randomized clinical trial Acad Emerg Med 15 2008 877 886
18. I.A. Erden, A.G. Pamuk, S.B. Akinci et al. Comparison of propofol-fentanyl with propofol-fentanyl-ketamine combination in pediatric patients undergoing interventional radiology procedures Paediatr Anaesth 19 2009 500 506
19. R.F. Donnelly, E. Willman, G. Andolfatto Stability of ketamine-propofol mixtures for procedural sedation and analgesia in the emergency department Can J Hosp Pharm 61 2008 426 430
20. G.Q. Sharieff, D.R. Trocinski, J.T. Kanegaye et al. Ketamine-propofol combination sedation for fracture reduction in the pediatric emergency department Pediatr Emerg Care 23 2007 881 884
21. D. Agrawal, S.F. Manzi, R. Gupta et al. Preprocedural fasting state and adverse events in children undergoing procedural sedation and analgesia in a pediatric emergency department Ann Emerg Med 42 2003 636 646
22. J.I. Apfelbaum, R.A. Caplan, R.T. Connis et al. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures. An updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters Anesthesiology 114 2011 495 511
23. J.A. Molina, C.A. Lobo, H.K. Goh et al. Review of studies and guidelines on fasting and procedural sedation at the emergency department Int J Evid Based Healthc 8 2010 75 78
24. R.J. Thorpe, J. Benger Pre-procedural fasting in emergency sedation Emerg Med J 27 2010 254 261
25. S.M. Green, M.G. Roback, J.R. Miner et al. Fasting and emergency department procedural sedation and analgesia: a consensus-based clinical practice advisory Ann Emerg Med 49 2007 454 461
26. M.G. Roback, L. Bajaj, J.E. Wathen et al. Preprocedural fasting and adverse events in procedural sedation and analgesia in a pediatric emergency department: are they related? Ann Emerg Med 44 2004 454 459
27. G. Treston Prolonged pre-procedure fasting time is unnecessary when using titrated intravenous ketamine for paediatric procedural sedation Emerg Med Australas 16 2004 145 150
28. F.E. Babl, A. Puspitadewi, P. Barnett et al. Preprocedural fasting state and adverse events in children receiving nitrous oxide for procedural sedation and analgesia Pediatr Emerg Care 21 2005 736 743
29. M.R. McKee, G.Q. Sharieff, J.T. Kanegaye et al. Oral analgesia before pediatric ketamine sedation is not associated with an increased risk of emesis and other adverse events J Emerg Med 35 2008 23 28
30. A. Bell, G. Treston, C. McNabb et al. Profiling adverse respiratory events and vomiting when using propofol for emergency department procedural sedation Emerg Med Australas 19 2007 405 410
31. J.R. Lightdale, D.A. Goldmann, H.A. Feldman et al. Microstream capnography improves patient monitoring during moderate sedation: a randomized, controlled trial Pediatrics 117 2006 e1170 e1178
32. M.A. Qadeer, J.J. Vargo, J.A. Dumot et al. Capnographic monitoring of respiratory activity improves safety of sedation for endoscopic cholangiopancreatography and ultrasonography Gastroenterology 136 2009 1568 1576
33. 2 monitoring during emergency department procedural sedation and analgesia with propofol decrease the incidence of hypoxic events? A randomized, controlled trial Ann Emerg Med 55 2010 258 264
34. J.B. Waugh, C.A. Epps, Y.A. Khodneva Capnography enhances surveillance of respiratory events during procedural sedation: a meta-analysis J Clin Anesth 23 2011 189 196
35. J.R. Miner, W. Heegaard, D. Plummer End-tidal carbon dioxide monitoring during procedural sedation Acad Emerg Med 9 2002 275 280
36. J.H. Burton, J.D. Harrah, C.A. Germann et al. Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices? Acad Emerg Med 13 2006 500 504
37. K. Deitch, C.R. Chudnofsky, P. Dominici The utility of supplemental oxygen during emergency department procedural sedation with propofol: a randomized controlled trial Ann Emerg Med 52 2008 1 8
38. J.J. Vargo, G. Zuccaro, J.A. Dumot et al. Automated graphic assessment of respiratory activity is superior to pulse oximetry and visual assessment for the detection of early respiratory depression during therapeutic upper endoscopy Gastrointest Endosc 55 2002 826 831
39. M.D. Mallory, A.L. Baxter, D.J. Yanosky et al. Emergency physician-administered propofol sedation: a report on 25,433 sedations from the Pediatric Sedation Research Consortium Ann Emerg Med 57 2011 462 468
40. J.P. Cravero, G.T. Blike, M. Beach et al. Incidence and nature of adverse events during pediatric sedation/anesthesia for procedures outside the operating room: report from the Pediatric Sedation Research Consortium Pediatrics 118 2006 1087 1096
41. Standards and Practice Parameters Committee, American Society of Anesthesiologists. Standards for basic anesthetic monitoring. July 1, 2011. Available at: http://www.asahq.org/Home/For-Members/Clinical-Information/Standards-Guidelines-and-Statements. Accessed: November 9, 2012.
42. R.G. Soto, E.S. Fu, H. Vila Jr. et al. Capnography accurately detects apnea during monitored anesthesia care Anesth Analg 99 2004 379 382
43. K. Deitch, C.R. Chudnofsky, P. Dominici The utility of supplemental oxygen during emergency department procedural sedation and analgesia with midazolam and fentanyl: a randomized, controlled trial Ann Emerg Med 49 2007 1 8
44. K. Deitch, C.R. Chudnofsky, P. Dominici et al. The utility of high-flow oxygen during emergency department procedural sedation and analgesia with propofol: a randomized, controlled trial Ann Emerg Med 58 2011 360 364
45. J.L. Anderson, E. Junkins, C. Pribble et al. Capnography and depth of sedation during propofol sedation in children Ann Emerg Med 49 2007 9 13
46. M.L. Sivilotti, D.W. Messenger, J. van Vlymen et al. A comparative evaluation of capnometry versus pulse oximetry during procedural sedation and analgesia on room air CJEM 12 2010 397 404
47. T.E. Terndrup, R.M. Cantor, C.M. Madden Intramuscular meperidine, promethazine, and chlorpromazine: analysis of use and complications in 487 pediatric emergency department patients Ann Emerg Med 18 1989 528 533
48. C.R. Chudnofsky, S.W. Wright, S.C. Dronen et al. The safety of fentanyl use in the emergency department Ann Emerg Med 18 1989 635 639
49. C.R. Chudnofsky, J.E. Weber, P.J. Stoyanoff et al. A combination of midazolam and ketamine for procedural sedation and analgesia in adult emergency department patients Acad Emerg Med 7 2000 228 235
50. R.J. Dachs, G.M. Innes Intravenous ketamine sedation of pediatric patients in the emergency department Ann Emerg Med 29 1997 146 150
51. W.G. Barsan, A.J. Tomassoni, D. Seger et al. Safety assessment of high-dose narcotic analgesia for emergency department procedures Ann Emerg Med 22 1993 1444 1449
52. D.R. Vinson, D.R. Bradbury Etomidate for procedural sedation in emergency medicine Ann Emerg Med 39 2002 592 598
53. W.J. Ruth, J.H. Burton, A.J. Bock Intravenous etomidate for procedural sedation in emergency department patients Acad Emerg Med 8 2001 13 18
54. C.J. Havel Jr., R.T. Strait, H. Hennes A clinical trial of propofol vs. midazolam for procedural sedation in a pediatric emergency department Acad Emerg Med 6 1999 989 997
55. E. Guenther, C.G. Pribble, E.P. Junkins Jr. et al. Propofol sedation by emergency physicians for elective pediatric outpatient procedures Ann Emerg Med 42 2003 783 791
56. K.E. Bassett, J.L. Anderson, C.G. Pribble et al. Propofol for procedural sedation in children in the emergency department Ann Emerg Med 42 2003 773 782
57. R.E. O'Connor, A. Sama, J.H. Burton et al. American College of Emergency Physicians. Procedural sedation and analgesia in the emergency department: recommendations for physician credentialing, privileging, and practice Ann Emerg Med 58 2011 365 370
58. A. Sacchetti, G. Senula, J. Strickland et al. Procedural sedation in the community emergency department: initial results of the ProSCED registry Acad Emerg Med 14 2007 41 46
59. K. Hogan, A. Sacchetti, L. Aman et al. The safety of single-physician procedural sedation in the emergency department Emerg Med J 23 2006 922 923
60. D.R. Vinson, C.L. Hoehn Sedation-assisted orthopedic reduction in emergency medicine: the safety and success of a one physician/one nurse model West J Emerg Med 14 2013 47 54
61. J.R. Miner, M.L. Martel, M. Meyer et al. Procedural sedation of critically ill patients in the emergency department Acad Emerg Med 12 2005 124 128
62. J.R. Miner, J.H. Burton Clinical practice advisory: emergency department procedural sedation with propofol Ann Emerg Med 50 2007 182 187
63. J.H. Burton, J.R. Miner, E.R. Shipley et al. Propofol for emergency department procedural sedation and analgesia: a tale of three centers Acad Emerg Med 13 2006 24 30
64. M.I. Kuypers, F. Mencl, M.F. Verhagen et al. Safety and efficacy of procedural sedation with propofol in a country with a young emergency medicine training program Eur J Emerg Med 18 2011 162 167
65. G. Senula, A. Sacchetti, S. Moore et al. Impact of addition of propofol to ED formulary Am J Emerg Med 28 2010 880 883
66. J.R. Miner, R.O. Gray, D. Stephens et al. Randomized clinical trial of propofol with and without alfentanil for deep procedural sedation in the emergency department Acad Emerg Med 16 2009 825 834
67. C.S. Weaver, W.E. Hauter, E.J. Brizendine et al. Emergency department procedural sedation with propofol: is it safe? J Emerg Med 33 2007 355 361
68. J.R. Miner, R.O. Gray, J. Bahr et al. Randomized clinical trial of propofol versus ketamine for procedural sedation in the emergency department Acad Emerg Med 17 2010 604 611
69. W. Phillips, A. Anderson, M. Rosengreen et al. Propofol versus propofol/ketamine for brief painful procedures in the emergency department: clinical and bispectral index scale comparison J Pain Palliat Care Pharmacother 24 2010 349 355
70. A. McQueen, R.O. Wright, M.M. Kido et al. Procedural sedation and analgesia outcomes in children after discharge from the emergency department: ketamine versus fentanyl/midazolam Ann Emerg Med 54 2009 191 197
71. E. Melendez, R. Bachur Serious adverse events during procedural sedation with ketamine Pediatr Emerg Care 25 2009 325 328
72. S.M. Green, M.G. Roback, B. Krauss et al. Predictors of airway and respiratory adverse events with ketamine sedation in the emergency department: an individual-patient data meta-analysis of 8,282 children Ann Emerg Med 54 2009 158 168
73. S.M. Green, M.G. Roback, B. Krauss et al. Predictors of emesis and recovery agitation with emergency department ketamine sedation: an individual-patient data meta-analysis of 8,282 children Ann Emerg Med 54 2009 171 180
74. D. Dilli, Y. Dallar, N.H. Sorgui Intravenous ketamine plus midazolam vs. intravenous ketamine for sedation in lumbar puncture: a randomized controlled trial Indian Pediatr 45 2008 899 904
75. J.M. Vardy, N. Dignon, N. Mukherjee et al. Audit of the safety and effectiveness of ketamine for procedural sedation in the emergency department Emerg Med J 25 2008 579 582
76. A.H. Bleiberg, C.A. Salvaggio, L.C. Roy et al. Low-dose ketamine: efficacy in pediatric sedation Pediatr Emerg Care 23 2007 158 162
77. S.M. Green, T.S. Sherwin Incidence and severity of recovery agitation after ketamine sedation in young adults Am J Emerg Med 23 2005 142 144
78. A. Newton, L. Fitton Intravenous ketamine for adult procedural sedation in the emergency department: a prospective cohort study Emerg Med J 25 2008 498 501
79. R.J. Strayer, L.S. Nelson Adverse events associated with ketamine for procedural sedation in adults Am J Emerg Med 26 2008 985 1028
80. W.T. Langston, J.E. Wathen, M.G. Roback et al. Effect of ondansetron on the incidence of vomiting associated with ketamine sedation in children: a double-blind, randomized, placebo-controlled trial Ann Emerg Med 52 2008 30 34
81. L. Brown, S. Christian-Kopp, T.S. Sherwin et al. Adjunctive atropine is unnecessary during ketamine sedation in children Acad Emerg Med 15 2008 314 318
82. P. Heinz, G.C. Geelhoed, C. Wee et al. Is atropine needed with ketamine sedation? A prospective, randomised, double blind study Emerg Med J 23 2006 206 209
83. J.R. Miner, M. Danahy, A. Moch et al. Randomized clinical trial of etomidate versus propofol for procedural sedation in the emergency department Ann Emerg Med 49 2007 15 22
84. J.J. Lee-Jayaram, A. Green, J. Siembieda et al. Ketamine/midazolam versus etomidate/fentanyl: procedural sedation for pediatric orthopedic reductions Pediatr Emerg Care 26 2010 408 412
85. L. Di Liddo, A. D'Angelo, B. Nguyen et al. Etomidate versus midazolam for procedural sedation in pediatric outpatients: a randomized controlled trial Ann Emerg Med 48 2006 433 440
86. M. Cicero, J. Graneto Etomidate for procedural sedation in the elderly: a retrospective comparison between age groups Am J Emerg Med 29 2011 1111 1116
87. J.R. Miner, R. Gray, P. Delavari et al. Alfentanil for procedural sedation in the emergency department Ann Emerg Med 57 2011 117 121
88. M.J. Dunn, R. Mitchell, C. De Souza et al. Evaluation of propofol and remifentanil for intravenous sedation for reducing shoulder dislocations in the emergency department Emerg Med J 23 2006 57 58
89. B. Krauss, S.M. Green Procedural sedation and analgesia in children Lancet 367 2006 766 780
90. S.G. Van Keulen, J.H. Burton Myoclonus associated with etomidate for ED procedural sedation and analgesia Am J Emerg Med 21 2003 556 558
91. J. Falk, P.J. Zed Etomidate for procedural sedation in the emergency department Ann Pharmacother 38 2004 1272 1277
92. C.L. Schenarts, J.H. Burton, R.R. Riker Adrenocortical dysfunction following etomidate induction in emergency department patients Acad Emerg Med 8 2001 1 7
93. A. Absalom, D. Pledger, A. Kong Adrenocortical function in critically ill patients 24 h after a single dose of etomidate Anaesthesia 54 1999 861 867
94. B. Allolio, R. Stuttmann, U. Leonhard et al. Adrenocortical suppression by a single induction dose of etomidate Klin Wochenschr 62 1984 1014 1017
95. B. Allolio, H. Dorr, R. Stuttmann et al. Effect of a single bolus of etomidate upon eight major corticosteroid hormones and plasma ACTH Clin Endocrinol (Oxf) 22 1985 281 286
96. A. Sacchetti, J. Jachowski, J. Heisler et al. Remifentanil use in emergency department patients: initial experience Emerg Med J 29 2012 928 929
97. J. Jewett, W.J. Phillips Dexmedetomidine for procedural sedation in the emergency department Eur J Emerg Med 17 2010 60