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Chapter 22 - Procedural Sedation and Analgesia in Trauma

Published online by Cambridge University Press:  23 August 2019

Alex Koyfman
Affiliation:
University of Texas Southwestern Medical Center
Brit Long
Affiliation:
San Antonio Military Medical Center
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Summary

Procedural sedation and analgesia (PSA) is a core competency for emergency physicians (EP) that is commonly practiced.14 PSA entails suppressing a patient’s level of consciousness with sedative or dissociative agents to alleviate pain, anxiety, and suffering to enhance medical procedure performance and patient experience (Table 22.1).1,5

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Publisher: Cambridge University Press
Print publication year: 2019

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References

Godwin, SA, Caro, DA, Wolf, SJ, et al. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2005;45(2):177–96.Google Scholar
Miner, JR, Krauss, B. Procedural sedation and analgesia research: state of the art. Acad Emerg Med. 2007;14(2):170–78.Google Scholar
Bellolio, MF, Gilani, WI, Barrionuevo, P, et al. Incidence of adverse events in adults undergoing procedural sedation in the emergency department: a systematic review and meta-analysis. Acad Emerg Med. 2016;23(2):119–34.Google Scholar
Godwin, SA, Burton, JH, Gerardo, CJ, et al. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2014;63(2):247–58, e218.Google Scholar
Green, SM, Roback, MG, Kennedy, RM, Krauss, B. Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update. Ann Emerg Med. 2011;57(5):449–61.Google Scholar
Burton, JH, Miner, JR, Shipley, ER, et al. Propofol for emergency department procedural sedation and analgesia: a tale of three centers. Acad Emerg Med. 2006;13(1):2430.Google Scholar
Newstead, B, Bradburn, S, Appelboam, A, et al. Propofol for adult procedural sedation in a UK emergency department: safety profile in 1008 cases. Br J Anaesth. 2013;111(4):651–55.Google Scholar
Andolfatto, G, Abu-Laban, RB, Zed, PJ, et al. Ketamine-propofol combination (ketofol) versus propofol alone for emergency department procedural sedation and analgesia: a randomized double-blind trial. Ann Emerg Med. 2012;59(6):504–12, e501–2.CrossRefGoogle ScholarPubMed
Willman, EV, Andolfatto, G. A prospective evaluation of “ketofol” (ketamine/propofol combination) for procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2007;49(1):2330.Google Scholar
Ruth, WJ, Burton, JH, Bock, AJ. Intravenous etomidate for procedural sedation in emergency department patients. Acad Emerg Med. 2001;8(1):1318.Google Scholar
Miner, JR, Moore, JC, Austad, EJ, et al. Randomized, double-blinded, clinical trial of propofol, 1:1 propofol/ketamine, and 4:1 propofol/ketamine for deep procedural sedation in the emergency department. Ann Emerg Med. 2015;65(5):479–88, e472.Google Scholar
Uri, O, Behrbalk, E, Haim, A, Kaufman, E, Halpern, P. Procedural sedation with propofol for painful orthopaedic manipulation in the emergency department expedites patient management compared with a midazolam/ketamine regimen: a randomized prospective study. J Bone Joint Surg Am. 2011;93(24):2255–62.Google Scholar
Vassallo, J, Smith, JE, Bruijns, SR, Wallis, LA. Major incident triage: a consensus based definition of the essential life-saving interventions during the definitive care phase of a major incident. Injury. 2016;47(9):1898–902.Google Scholar
Adams, JG, Barton, ED, Collings, J, et al. Emergency Medicine: Expert Consult – Online. Amsterdam, The Netherlands: Elsevier Health Sciences; 2008.Google Scholar
Walls, R, Hockberger, R, Gausche-Hill, M. Rosen’s Emergency Medicine: Concepts and Clinical Practice: 2-Volume Set. Amsterdam, The Netherlands: Elsevier; 2017.Google Scholar
Tintinalli, J, Stapczynski, J, Ma, OJ, et al. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8th ed. New York, NY: McGraw-Hill Education; 2015.Google Scholar
Miner, JR, Martel, ML, Meyer, M, Reardon, R, Biros, MH. Procedural sedation of critically ill patients in the emergency department. Acad Emerg Med. 2005;12(2):124–28.Google Scholar
Daabiss, M. American Society of Anaesthesiologists physical status classification. Indian J Anaesth. 2011;55(2):111–15.Google Scholar
Green, SM, Krauss, B. Pulmonary aspiration risk during emergency department procedural sedation – an examination of the role of fasting and sedation depth. Acad Emerg Med. 2002;9(1):3542.Google Scholar
Burton, JH, Harrah, JD, Germann, CA, Dillon, DC. Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices? Acad Emerg Med. 2006;13(5):500–4.Google Scholar
Campbell, SG, Magee, KD, Zed, PJ, et al. End-tidal capnometry during emergency department procedural sedation and analgesia: A randomized, controlled study. World J Emerg Med. 2016;7(1):1318.Google Scholar
Dewdney, C, MacDougall, M, Blackburn, R, Lloyd, G, Gray, A. Capnography for procedural sedation in the ED: a systematic review. Emerg Med J. 2017;34(7):476–84.Google Scholar
Zeiler, FA, Teitelbaum, J, West, M, Gillman, LM. The ketamine effect on ICP in traumatic brain injury. Neurocrit Care. 2014;21(1):163–73.Google Scholar
Zeiler, FA, Teitelbaum, J, West, M, Gillman, LM. The ketamine effect on intracranial pressure in nontraumatic neurological illness. J Crit Care. 2014;29(6):1096–106.Google Scholar
Zeiler, FA, Sader, N, Gillman, LM, et al. The cerebrovascular response to ketamine: a systematic review of the animal and human literature. J Neurosurg Anesthesiol. 2016;28(2):123–40.Google Scholar
Oddo, M, Crippa, IA, Mehta, S, et al. Optimizing sedation in patients with acute brain injury. Crit Care. 2016;20(1):128.Google Scholar
Drayna, PC, Estrada, C, Wang, W, Saville, BR, Arnold, DH. Ketamine sedation is not associated with clinically meaningful elevation of intraocular pressure. Am J Emerg Med. 2012;30(7):1215–18.Google Scholar
Halstead, SM, Deakyne, SJ, Bajaj, L, Enzenauer, R, Roosevelt, GE. The effect of ketamine on intraocular pressure in pediatric patients during procedural sedation. Acad Emerg Med. 2012;19(10):1145–50.Google Scholar
Carney, N, Totten, AM, O’Reilly, C, et al. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 2017;80(1):615.Google Scholar
Andolfatto, G, Willman, E. A prospective case series of single-syringe ketamine-propofol (Ketofol) for emergency department procedural sedation and analgesia in adults. Acad Emerg Med. 2011;18(3):237–45.Google Scholar
Miner, J. Ketamine or ketofol: Do we have enough evidence to know which one to use? Acad Emerg Med. 2017:24(12):1511–13.Google Scholar
Green, SM, Krauss, B. Clinical practice guideline for emergency department ketamine dissociative sedation in children. Ann Emerg Med. 2004;44(5):460–71.Google Scholar
Meredith, JR, O’Keefe, KP, Galwankar, S. Pediatric procedural sedation and analgesia. J Emerg Trauma Shock. 2008;1(2):8896.Google Scholar
Apfelbaum, JL, Silverstein, JH, Chung, FF, et al. Practice guidelines for postanesthetic care: an updated report by the American Society of Anesthesiologists Task Force on Postanesthetic Care. Anesthesiology. 2013;118(2):291307.Google Scholar
Green, SM, Clark, R, Hostetler, MA, et al. Inadvertent ketamine overdose in children: clinical manifestations and outcome. Ann Emerg Med. 1999;34(4 Pt 1):492–97.Google Scholar
Green, SM, Kuppermann, N, Rothrock, SG, Hummel, CB, Ho, M. Predictors of adverse events with intramuscular ketamine sedation in children. Ann Emerg Med. 2000;35(1):3542.Google Scholar
Rodriguez, E, Jordan, R. Contemporary trends in pediatric sedation and analgesia. Emerg Med Clin North Am. 2002;20(1):199222.Google Scholar
Motas, D, McDermott, NB, VanSickle, T, Friesen, RH. Depth of consciousness and deep sedation attained in children as administered by nonanaesthesiologists in a children’s hospital. Paediatr Anaesth. 2004;14(3):256–60.Google Scholar
Dial, S, Silver, P, Bock, K, Sagy, M. Pediatric sedation for procedures titrated to a desired degree of immobility results in unpredictable depth of sedation. Pediatr Emerg Care. 2001;17(6):414–20.Google Scholar
Maxwell, LG, Yaster, M. The myth of conscious sedation. Arch Pediatr Adolesc Med. 1996;150(7):665–67.CrossRefGoogle ScholarPubMed
Cote, CJ, Notterman, DA, Karl, HW, Weinberg, JA, McCloskey, C. Adverse sedation events in pediatrics: a critical incident analysis of contributing factors. Pediatrics. 2000;105(4 Pt 1):805–14.Google Scholar
Morton, NS, Oomen, GJ. Development of a selection and monitoring protocol for safe sedation of children. Paediatr Anaesth. 1998;8(1):6568.CrossRefGoogle ScholarPubMed
Green, SM. Fasting is a consideration – not a necessity – for emergency department procedural sedation and analgesia. Ann Emerg Med. 2003;42(5):647–50.Google Scholar
Agrawal, D, Manzi, SF, Gupta, R, Krauss, B. Preprocedural fasting state and adverse events in children undergoing procedural sedation and analgesia in a pediatric emergency department. Ann Emerg Med. 2003;42(5):636–46.Google Scholar
Malviya, S, Voepel-Lewis, T, Tait, AR, et al. Depth of sedation in children undergoing computed tomography: validity and reliability of the University of Michigan Sedation Scale (UMSS). Br J Anaesth. 2002;88(2):241–45.Google Scholar
American Academy of Pediatrics, American Academy of Pediatric Dentistry, Cote, CJ, Wilson, S, Work Group on Sedation. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: An update. Paediatr Anaesth. 2008;18(1):910.Google Scholar
Soma-Pillay, P, Nelson-Piercy, C, Tolppanen, H, Mebazaa, A. Physiological changes in pregnancy. Cardiovasc J Afr. 2016;27(2):8994.Google Scholar
Qureshi, WA, Rajan, E, Adler, DG, et al. ASGE guideline: guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc. 2005;61(3):357–62.CrossRefGoogle ScholarPubMed
Weaver, CS, Terrell, KM, Bassett, R, et al. ED procedural sedation of elderly patients: is it safe? Am J Emerg Med. 2011;29(5):541–44.Google Scholar
Yano, H, Iishi, H, Tatsuta, M, et al. Oxygen desaturation during sedation for colonoscopy in elderly patients. Hepatogastroenterology. 1998;45(24):2138–41.Google Scholar
Taylor, DM, Bell, A, Holdgate, A, et al. Risk factors for sedation-related events during procedural sedation in the emergency department. Emerg Med Australas. 2011;23(4):466–73.Google Scholar
Green, SM, Andolfatto, G. Managing propofol-induced hypoventilation. Ann Emerg Med. 2015;65(1):5760.Google Scholar
Kitagawa, E, Iida, A, Kimura, Y, et al. Responses to intravenous sedation by elderly patients at the Hokkaido University Dental Hospital. Anesth Prog. 1992;39(3):7378.Google Scholar
Campbell, RL, Smith, PB. Intravenous sedation in 200 geriatric patients undergoing office oral surgery. Anesth Prog. 1997;44(2):6467.Google Scholar
Patanwala, AE, Christich, AC, Jasiak, KD, et al. Age-related differences in propofol dosing for procedural sedation in the Emergency Department. J Emerg Med. 2013;44(4):823–28.Google Scholar
Stefansson, T, Wickstrom, I, Haljamae, H. Hemodynamic and metabolic effects of ketamine anesthesia in the geriatric patient. Acta Anaesthesiol Scand. 1982;26(4):371–77.Google Scholar
Jabre, P, Combes, X, Lapostolle, F, et al. Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial. Lancet. 2009;374(9686):293300.Google Scholar
Wickstrom, I, Holmberg, I, Stefansson, T. Survival of female geriatric patients after hip fracture surgery. A comparison of 5 anesthetic methods. Acta Anaesthesiol Scand. 1982;26(6):607–14.Google Scholar
Cicero, M, Graneto, J. Etomidate for procedural sedation in the elderly: a retrospective comparison between age groups. Am J Emerg Med. 2011;29(9):1111–16.Google Scholar
Hughes, CG, McGrane, S, Pandharipande, PP. Sedation in the intensive care setting. Clin Pharmacol. 2012;4:5363.Google Scholar

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