Challenges in procedural sedation and analgesia in the emergency department
Violetta Raffay, Z Fiser, Evangelia Samara, Kalliopi Magounaki, Dimitrios Chatzis, Georgios Mavrovounis, Maria Mermiri, Filip Žunić, Ioannis Pantazopoulos
Abstract
Abstract: Procedural sedation and analgesia (PSA) constitute a common practice aiming to relieve patients’ anxiety, discomfort and pain during invasive diagnostic and therapeutic procedures in the emergency department (ED). The PSA has increased recognition by different specialties, such as Emergency Medicine, Pediatrics, Dentistry, Gastroenterology, Orthopedic, and General Surgery. However, PSA is usually used in orthopedic interventions, abscess incisions, and cardioversion. Desirably, the ideal agent for PSA in the ED should provide anxiolysis, analgesia and amnesia in a rapid, predictable manner, with minimal side effects, and should have a quick recovery phase. Today, there is significant variation in PSA administration, based on individual institutional parameters and physician preferences despite the extensive efforts of several organizations and medical societies to provide universal evidence-based guidelines. Also, a variety of logistic and practical difficulties, such as drug availability and appropriate personnel training, prevent the implementation of global guidelines regarding PSA in the ED. Nevertheless, the proper drug and management strategy has yet to be defined. In the present review, we discuss the assessment and monitoring necessary for PSA administration, the most commonly available and used pharmaceutical agents and the required knowledge, skills, and interventions that are necessary to manage potential complications related to PSA in the ED setting.