Procedural sedation in the emergency department by Dutch emergency physicians: A prospective multicentre observational study of 1711 adults

Gaël J.P. Smits, Maybritt I. Kuypers, Lisette A.A. Mignot, Eef P.J. Reijners, Erick Oskam, Karen van Doorn, Wendy A.M.H. Thijssen, Erik H.M. Korsten

Research output: Contribution to journalArticleAcademicpeer-review

10 Citations (Scopus)
34 Downloads (Pure)

Abstract

Objective: To describe our experience performing ED procedural sedation in a country where emergency medicine (EM) is a relatively new specialty. Methods: This is a prospective observational study of adult patients undergoing procedural sedation by emergency physicians (EPs) or EM residents in eight hospitals in the Netherlands. Data were collected on a standardised form, including patient characteristics, sedative and analgesic used, procedural success, adverse events (classified according to World SIVA) and rescue interventions. Results: 1711 adult cases were included from 2006 to 2013. Propofol, midazolam and esketamine (S+ enantiomer of ketamine) were the most used sedatives (63%, 29% and 8%). We had adverse event data on all patients. The overall adverse event rate was 11%, mostly hypoxia or apnoea. There was no difference in adverse event rate between EPs and EM residents. However, there was a significantly higher success rate of the procedure when EPs did the procedural sedation (92% vs 84%). No moderate (unplanned hospital admission or escalation of care) or sentinel SIVA outcomes occurred ( pulmonary aspiration syndrome, death or permanent neurological deficit). Conclusion: Adverse events during procedural sedation occurred in 11% of patients. There were no moderate or sentinel outcomes. All events could be managed by the sedating physician. In a country where EM is a relatively new specialty, procedural sedation appears to be safe when performed by EPs or trained EM residents and has comparable adverse event rates to international studies.

Original languageEnglish
Pages (from-to)237-242
Number of pages6
JournalEmergency Medicine Journal (EMJ)
Volume34
Issue number4
DOIs
Publication statusPublished - Apr 2017

Keywords

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesia/methods
  • Clinical Competence/standards
  • Conscious Sedation/methods
  • Emergency Service, Hospital/organization & administration
  • Female
  • Humans
  • Hypnotics and Sedatives/pharmacology
  • Ketamine/pharmacology
  • Male
  • Midazolam/pharmacology
  • Middle Aged
  • Netherlands
  • Physicians/standards
  • Propofol/pharmacology
  • Prospective Studies
  • Statistics, Nonparametric
  • Treatment Outcome

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