Procedural sedation of adult patients in ED
A best practice implementation project
Procedural sedation, also known as conscious or moderate sedation, is distinct from general anaesthesia in that it aims to maintain the patient's consciousness while alleviating discomfort. Unlike general anaesthesia, where patients are rendered unconscious and often require assisted ventilation, procedural sedation allows patients to maintain airway patency, protective airway reflexes, spontaneous respirations, and hemodynamic stability.
Procedural sedation has become increasingly common in the medical landscape, especially in settings like the emergency department (ED) and intensive care unit. It is a valuable tool for managing pain and anxiety during diagnostic or therapeutic procedures, offering a balance between patient comfort and safety. However, the fast-paced environment of the ED can sometimes compromise the adherence to evidence-based practices during procedural sedation, potentially leading to adverse events.
Procedural sedation carries risks for adverse events, including cardiac arrest, respiratory complications, and haemodynamic instability. These risks underscore the importance of adhering to evidence-based guidelines and safety protocols during procedural sedation procedures.
Key components of evidence-based procedural sedation in the ED include continuous monitoring of vital signs such as heart rate, oxygen saturation, respiratory rate, and non-invasive blood pressure. Additionally, the American Society of Anesthesiology recommends monitoring core body temperature and continuous capnography to detect respiratory depression early.
To minimise the risk of adverse events, it is essential to ensure that a trained physician and nurse are present throughout the procedure, maintaining constant vigilance and promptly addressing any complications that may arise. Moreover adherence to discharge criteria, such as the Aldrete Discharge Readiness Tool, are essential steps in ensuring patient safety post-procedure.
A best practice implementation project was conducted to improve evidence-based practices during the procedural sedation of adult patients in the ED at a large hospital in the United States.
Read about the project in JBI Evidence Implementation:
Resources
Procedural sedation of adult patients in the emergency department: a best practice implementation project
Pickens, Jessica; Garbo, Candon
JBI Evidence Implementation. 22(1):44-52, February 2024.