Procedural Sedation and Analgesia in the Emergency Department

Publication Date: October 1, 2013
Last Updated: March 14, 2022

Recommendations

Do not delay procedural sedation in adults or pediatrics in the ED based on fasting time. Preprocedural fasting for any duration has not demonstrated a reduction in the risk of emesis or aspiration when administering procedural sedation and analgesia. (B)
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Capnography may be used as an adjunct to pulse oximetry and clinical assessment to detect hypoventilation and apnea earlier than pulse oximetry and/or clinical assessment alone in patients undergoing procedural sedation and analgesia in the ED. (B)
*Capnography includes all forms of quantitative exhaled carbon dioxide analysis.
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During procedural sedation and analgesia, a nurse or other qualified individual should be present for continuous monitoring of the patient, in addition to the provider performing the procedure. Physicians who are working or consulting in the ED should coordinate procedures requiring procedural sedation and analgesia with the ED staff. (C)
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Ketamine can be safely administered to children for procedural sedation and analgesia in the ED. Propofol can be safely administered to children and adults for procedural sedation and analgesia in the ED. (A)
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Etomidate can be safely administered to adults for procedural sedation and analgesia in the ED. A combination of propofol and ketamine can be safely administered to children and adults for procedural sedation and analgesia. (B)
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Ketamine can be safely administered to adults for procedural sedation and analgesia in the ED. Alfentanil can be safely administered to adults for procedural sedation and analgesia in the ED. Etomidate can be safely administered to children for procedural sedation and analgesia in the ED. (C)
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Recommendation Grading

Overview

Title

Procedural Sedation and Analgesia in the Emergency Department

Authoring Organization

American College of Emergency Physicians

Publication Month/Year

October 1, 2013

Last Updated Month/Year

September 13, 2023

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Critical questions relevant to the current practice of emergency medicine were developed for this revision, which addresses critical questions in addition to offering a summary of recent concepts, agents, and developments in procedural sedation and analgesia

Target Patient Population

Patients with emergent and urgent conditions that require procedural sedation with or without analgesia in the emergency department (ED)

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Emergency care

Intended Users

Paramedic emt, nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Management

Diseases/Conditions (MeSH)

D000698 - Analgesia, D000700 - Analgesics, D054810 - Deep Sedation, D016292 - Conscious Sedation

Keywords

sedation, analgesia, procedural sedation

Source Citation

Ann Emerg Med. 2014;63:247-258.

Methodology

Number of Source Documents
97
Literature Search Start Date
January 1, 2004
Literature Search End Date
May 1, 2012