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Emergency department procedural sedation and analgesia: A Canadian Community Effectiveness and Safety Study (ACCESS)

Published online by Cambridge University Press:  21 May 2015

Mark Mensour ,
Robert Pineau ,
Vic Sahai  and
Jennifer Michaud
Mark Mensour*
Affiliation:
Department of Emergency Medicine, Northern Ontario School of Medicine, East Campus, Sudbury, Ont.; Resident Evaluation Coordinator, Northeastern Ontario Family Medicine Program; Emergency Medicine and Anesthesia, Huntsville District Memorial Hospital, Huntsville, Ont.
Robert Pineau
Affiliation:
Resident in Family Medicine, Emergency Medicine Program, Northeastern Ontario Family Medicine Program
Vic Sahai
Affiliation:
Northern Health Information Partnership, Northeastern Ontario Medical Education Corporation; Health Informatics, Northern Ontario School of Medicine, East Campus, Sudbury, Ont.
Jennifer Michaud
Affiliation:
Northeastern Ontario Medical Education Corporation
*
Muskoka East-Perry Sound Health Services, Huntsville District Memorial Hospital, 100 Frank Miller Dr., Huntsville ON P1H 1H7; mensours@cogeco.ca

Abstract

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Objectives:

To determine the effectiveness and safety of procedural sedation and analgesia (PSA) in a Canadian community emergency department (ED) staffed primarily by family physicians and to assess the role of capnometry monitoring in PSA.

Methods:

One hundred and sixty (160) consecutive procedural sedation cases were reviewed from the ED of a rural hospital in Huntsville, Ont. The ED is mainly staffed by family physicians who have received in-house training in PSA. Safety and effectiveness measures were extrapolated from a standardized PSA form by a blinded research assistant.

Results:

The mean age of the patient population was 33.6 years (standard deviation = 23.6). Fifty-four percent of the patients were male, and 33% of the cases were pediatric. PSA medications included propofol (84%), fentanyl (51%) and midazolam (15%), and the procedural success rate was 95.6%. The adverse event (AE) rate was 18% and included apnea (10%), inadequate sedation (3%), bradycardia (2%), desaturation (1%), hypotension (1%) and bag-valve-mask use (1%). In those aged ≥65 years there was a greater incidence of apnea. There were no episodes of emesis and there were no intubations. A modified jaw thrust manoeuvre was used in 23% of the cases. In the 64% of cases where capnometry was used, there was no association between its use and any AE measures.

Conclusion:

Procedural sedation was safe and effective in our environment. Capnometry recording did not appear to alter outcomes, although the data are incomplete.

Keywords

emergency department, ruralemergency department, communityfamily physiciansgeneral practitionerssafety effectivenesscapnometryprocedural sedation and analgesia
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 8 , Issue 2 , March 2006 , pp. 94 - 99
Copyright
Copyright © Canadian Association of Emergency Physicians 2006

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