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Background:
Brief Report

Procedural Sedation and Analgesia in an Australian Emergency Department: Results of the First 3 Months of a Procedural Sedation Registry

by
Viet Tran
1,2,3,4,*,
James Whitfield
1,
Natasha Askaroff
1 and
Giles Barrington
1,2,3
1
Royal Hobart Hospital, Tasmanian Health Service, Hobart 7000, Australia
2
Tasmanian School of Medicine, University of Tasmania, Hobart 7000, Australia
3
TASER (Tasmanian Emergency Medicine Research) Institute, Hobart 7000, Australia
4
Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
*
Author to whom correspondence should be addressed.
Anesth. Res. 2024, 1(3), 157-167; https://doi.org/10.3390/anesthres1030015
Submission received: 3 September 2024 / Revised: 20 September 2024 / Accepted: 23 September 2024 / Published: 1 October 2024
Browse Figure
Review Reports Versions Notes

Abstract

:
Background: Procedural sedation and analgesia (PSA) is commonly performed in emergency departments (EDs) to reduce anxiety, discomfort, or pain during a procedure. The primary goal of PSA is to produce a state of relaxation and drowsiness without eliminating the patient’s protective reflexes. Despite the discovery of new techniques and medications to deliver PSA, there is a paucity of research evaluating PSA in EDs over the last decade. We aim to describe the current practice of PSA in an Australian tertiary mixed ED with 75,000 presentations per year. Methods: A retrospective study of the initial 3 months of a PSA registry, which was part of the Tasmanian Emergency Care Outcomes Registry, was analyzed; Results: All told, 80 consecutive cases were entered over a 3-month period, with pediatric patients (<14 years old) making up 35% of all cases. Joint reductions (17, 39%) and fracture reductions (13, 29%) were the most common indications for the adult population, whilst fracture reductions (9, 36%), laceration repairs (7, 28%), and other distressing procedures (7, 28%) were the most common indications in the pediatric cohort. Pharmacological approaches also differed between groups, with ketamine (25, 92%) preferred in the pediatric cohort whilst the combination of propofol and fentanyl (22, 42%) was preferred in the adult cohort. No adverse events were recorded in the pediatric cohort whilst 6 (8%) minor events occurred in the adult population, with no severe events occurring for either cohort. PSA also occurred more frequently at 0900–1000 and the incidence was reduced between 0000 and 0800. Conclusions: PSA is commonly performed in our tertiary mixed ED and is both safe and effective, with non-severe complication rates similar to those in the reported literature. Severe complications are rare and therefore a larger cohort will be required to assess this aspect. The approach to ED PSA is also different between pediatric and adult populations and therefore research needs to differentiate both populations.

1. Introduction

1.1. Procedural Sedation

Procedural sedation and analgesia (PSA), also known as conscious sedation, refers to the administration of sedative medications to induce a state of decreased consciousness while maintaining the patient’s ability to respond to verbal commands and protective reflexes [1,2,3]. This technique is commonly employed in various medical procedures, such as endoscopies, certain surgeries, and diagnostic imaging, to alleviate anxiety, discomfort, or pain [4].
The concept of PSA has evolved over time with advancements in anesthesia and procedural medicine. While the precise origin or first description of PSA may not have a single definitive point, its development can be traced back to the early to mid-20th century when anaesthesiologists began exploring techniques to achieve varying levels of sedation and analgesia for medical procedures [3,5,6].
The primary goal of PSA is to achieve a level of sedation that allows the procedure to be performed safely and effectively while minimizing the risks associated with deeper levels of sedation or general anesthesia, such as apnea, the absence of airway protection, and hemodynamic instability [1,2,7]. The continuous monitoring of vital signs, respiratory function, and responsiveness is therefore essential during PSA to ensure patient safety and optimize outcomes [1,4,7].

1.2. Procedural Sedation in the Emergency Department

The emergency department (ED) serves as an optimal setting for performing safe and effective PSA for conditions such as reductions in fractures or joint dislocations and wound repairs due to its unique combination of urgency, expertise, and resources [1,8]. Performing PSA in the ED provides an additional benefit to the health service, as the procedures would have to otherwise be performed in the operating theater and compete with other cases that require the operating theater. For the patient, this would also mean that the time required to complete the procedure would be prolonged. Given the health service benefits of performing PSA in the ED, guidelines and emergency medicine training also include PSA within their scope of practice [9]. The comprehensive facilities and resources available in the ED, including advanced monitoring equipment and immediate access to resuscitation measures, further enhance the safety and efficacy of procedural sedation in this setting [9]. Team leaders are often delegated to co-ordinate all aspects of a PSA and are commonly ED specialists, although more complex scenarios may involve other critical care specialists taking on this role in the ED. ED specialists are trained in and familiar with the use of pharmacological agents used for PSA and the management of complications that may arise [9,10,11].
Pharmacological approaches to ED PSA are nuanced, considering a variety of pharmacodynamics that may assist or adversely affect the patient. The sedative medication propofol causes muscle relaxation, thereby improving the efficacy of joint reductions, whereas procedural medication such as ketamine does not [12]. Despite this, ketamine has increased in popularity as it provides analgesia and does not affect respiration, inducing dissociative anesthesia (rather than sedation) [11,12]. Ketamine is therefore the preferred medication in the pediatric population, although there is still no universally preferred approach for the adult population [9,13,14,15,16]. Due to the complexity of patient factors and the process itself, the medication and resources used to deliver PSA vary considerably around the world [7,13,14,15,16,17,18].

1.3. Quality and Safety of Procedural Sedation in Emergency Departments

The practice of PSA is complex and potentially high-risk as the medications used to reduce pain and induce sedation, at higher doses, can cause apnoea, agitation, aspiration, and other adverse effects [19,20]. Equally, at lower doses, patients may experience pain and distress, or it may not be possible to complete the procedure. Around the time that PSA in ED became commonplace, the safety profile of PSA was assessed and found to be relatively safe, despite the lack of consistency with how it was performed [19,20,21].
Part of the safety profile of PSA relies on targeted and thorough risk assessment. There is currently no validated risk assessment tool for use in ED PSA, with many local tools and guidelines relying on aspects of the anesthetic literature. These risk assessments include previous anesthetic complications, structured airway assessments, contemporaneous vital sign monitoring, and physical health status as determined according to the American Society of Anesthesiology (ASA) [22]. Fasting status often forms part of the risk assessment, although recent evidence suggests that this may no longer be relevant [23,24].
Over the last decade, much has changed about the ED environment, patient profiles, and the medications available or considered safe for PSA [25,26,27]. A major confounder to safe care in EDs internationally has been the surge in hospital access block, leading to ED overcrowding and accompanying increases in morbidity and mortality [28,29,30,31,32]. The practice of PSA in ED has also been affected by these changes, but it is unclear to what extent.

1.4. Review of Local Procedural Sedation Quality and Safety through a Registry Design

To understand PSA practices at our tertiary hospital, a procedural sedation subgroup was created as part of the Tasmanian Emergency Care Outcomes Registry (TECOR) [33]. We aim to describe PSA practices for the first 3 months of this subgroup’s existence. This offers a chance to identify the characteristics and safety profile of PSA in our context and within the modern era of ED overcrowding, which has not been previously reported.

2. Materials and Methods

2.1. Setting

This study was conducted in a major tertiary referral–teaching mixed ED in Australia with an annual presentation rate of just over 75,000 patients, of which approximately 35% are less than 14 years old. Pediatric patients were defined as less than 14 years of age, in line with local definitions. The ED uses a hybrid medical records system, with patient tracking and patient notes captured electronically, whilst patient observations, medications, and fluids are charted on paper. The ED uses a separate paper form to record all aspects of PSA, including risk assessment, medication prescriptions, and vital sign recording during the procedure. This form is scanned into the patient electronic records and a unique barcode allows the identification of this form. Our ED is staffed by a range of doctors, including specialists, registrars, residents, and interns.

2.2. Methods

A retrospective observational study of the first 3 months of the TECOR PSA subgroup was analyzed (starting on the 1 January 2022). Procedural sedations were identified when a PSA form was completed. The primary objective was to determine if our ED PSA cases were induced safely when compared with the literature. Secondary objectives included establishing the incidence of, indications for, and pharmacological approaches to ED PSA. Inclusion criteria included all patients who underwent a PSA in the ED for any reason. Exclusion criteria included duplicate entries, entries where a PSA form was created but the PSA never took place, and patients who underwent intravenous regional anesthesia (typically of the upper limb, also known as a Bier’s block) without evidence of the administration of the medication used for PSA.

2.3. Data Analysis

Descriptive statistics were used to summarize the data. Categorical variables were presented as frequencies and their percentages and continuous variables were depicted as means and standard deviations (SDs) or medians and interquartile ranges (IQRs), as appropriate.

2.4. Ethical Approval

Ethical approval was provided by the Tasmania Health and Medical Human Research Ethics Committee on 15 March 2021, with a code of HREC24024. The approval of the Department of Health Research Governance Office was also obtained on 31 May 2023, with a code of SSA453.

3. Results

3.1. Patient Demographics

Within the first 3 months (from 1 January 2022 to March 2022), 80 consecutive PSA cases were induced in our ED (Table 1). Of these, 34 (42%) PSA cases were induced in female patients and 46 (58%) were induced in male patients. Pediatric patients were defined as those less than 14 years of age at the time of PSA, and this included 28 (35%) patients. The mean age for pediatric patients was 6.9 years (SD 4.3 IQR 3.0–10.0) and for adults it was 48.8 years (SD 23.4, IQR 26.5–70.5). The oldest patient was 89 years old.

3.2. Documentation

Not all areas of the PSA form were completed, with the variable neglect of most sections. The most poorly documented sections were prior anesthetic complications (40, 50%), co-morbidities (36, 45%) and pre-procedural physiological status (35, 44%). The most complete sections included medication prescriptions (78, 99%), structured airway assessments (72, 90%), and indications (69, 86%) (Table 2).

3.3. Procedure Profile

During the first 3 months recorded in the registry, 47 (98%) PSA cases were identified as being led by a staff member of the ED and 1 (2%) was led by a member of the anesthetics department (Table 3). For patients where PSA was induced by the ED, there was variety in terms of the seniority of those performing this role, including 31 (66%) specialists and 16 (34%) registrars. Subgroup analysis of pediatric PSA cases showed that this ratio differed by team leader seniority, with 15 (75%) PSA cases led by a specialist compared with 16 (60%) in the adult cohort.
With regard to the reason for PSA, joint reductions (19, 27%) and fracture reductions (22, 32%) contributed to over half of all indications documented. Subgroup analysis of pediatric PSA cases showed differences in the reasons for PSA, with fracture reduction (9, 36%), laceration repairs (7, 28%), and other painful procedures (7, 28%) contributing to over 90% all indications. For adults, the most common indications were joint reduction (17, 39%), fracture reduction (13, 29%), and cardioversion (11, 25%).
A structured airway assessment was performed in 67 (93%) cases. The structured airway assessment formed part of the risk assessment to predict difficulty and also included clinician synthesis of other clinical, operator, and environmental factors. A difficult airway was predicted in 1 (2%) patient. Fasting status was variable and there were 24 (50%) patients fasting for more than 6 h and 24 (50%) fasting for 6 h or less.
When considering the risk of adverse events relating to PSA, among all documented cases, 42 (93%) had normal pre-procedural physiological status and 3 (8%) had previous anesthetic complications. ASA distributions ranged from 1 (35, 65%), to 2 (14, 26%), to 3 (4, 7%), to 4 (1, 2%), and to 5 (0%).
In terms of the time of day, over the 3-month period, the highest mean frequency was seen at 0900, where 9 PSA cases were induced, with the lowest (no PSA cases) occurring at 0200, 0400, and 0700 (Figure 1).

3.4. Sedation Profile

Pharmacological approaches in PSA for the first 3 months of consecutive PSA cases in our registry favored ketamine (31, 40%) or a combination of propofol and fentanyl (22, 29%). Propofol was used either alone or in combination in 43 (55%) of all PSA cases. Approaches were also different between pediatric and adult populations, with the pediatric population favoring ketamine (25, 92%) whilst the adult population favored propofol and fentanyl (22, 43%) or propofol alone (17, 33%).

3.5. Adverse Effects

Six complications were recorded, of which 4 (10%) related to desaturation, 2 (6%) related to hemodynamic instability, and none related to airway compromise or severe events. No complications were recorded for the pediatric cohort.

3.6. Disposition

In terms of disposition, 21 (42%) were discharged to their usual place of residence, 9 were sent (18%) to the short-stay unit, 19 (38%) were admitted to an inpatient unit, and 1 was sent (2%) to the theater.

4. Discussion

Procedural sedation in the ED is a necessary tool to expedite the timely management of patient care [1]. The incidence, techniques, and safety profile of PSA have not previously been explored in detail in a Tasmanian context or in the era of ED overcrowding.
The data reported captured all consecutive PSA cases entered into TECOR in the first three months (90 days) of launch. This amounted to 80 episodes or just under 1 PSA case per day if the distribution was normal. We were unable to find any reported literature that defined how often PSA was being induced in EDs.

4.1. ED PSA in the Pediatric Population (<14 Years)

There were 6500 (35%) pediatric (<14 years) presentations to our ED over the study time period. For this same time period, the PSA registry captured 28 (35%) patients in the same age range. The mean age for pediatric patients was 6.9 years (SD 4.3, IQR 3.0–10.0). Data from the Australian Institute of Health and Welfare (AIHW) showed that children aged 1–4 years experienced a higher rate of injury-related ED presentations than adults for most injury types [34]. In our review, laceration repairs were a much more common indication in the pediatric population when compared with the adult population (7, 28% vs. 1, 2%). This is in agreement with AIHW data reporting that open wounds have a rate ratio of 3.0 compared with adults [34]. This also suggests that patient factors that influence the need for a PSA differ between pediatric and adult populations, with a more prominent psychological influence on pediatric patients [2].
Pharmacological approaches to ED PSA are nuanced, incorporating a variety of pharmacodynamics and pharmacokinetics that may assist or adversely affect the patient [12]. The prominence of ketamine as a sole agent for inducing ED PSA in pediatrics compared with adults (25, 92% vs. 6, 12%) in our study is consistent with practices worldwide [2]. Although ketamine has fewer physiological adverse effects in the adult population, the emergence phenomenon (an unpleasant psychiatric effect on waking) limits its utilization in the adult population [10,11,35,36]. This phenomenon has been reported as occurring in between 4 and 20% of ketamine ED PSA cases [10]. Johnson et al. studied patient satisfaction with procedural sedation in the context of indication and a pharmacological approach at two large EDs and interestingly the use of ketamine was not featured [37].

4.2. ED PSA in the Adult Population (14 Years and Over)

Whereas ED PSA serves to alleviate psychological discomfort in the pediatric population, its utilization in the adult population derives primarily from physiologically painful procedures, with joint reduction (17, 39%) being the most common indication, followed by fracture reduction (13, 29%) and cardioversion (11, 25%).
The indications for ED PSA may contribute to the pharmacological preferences in the adult population, with the combination of propofol and fentanyl (22, 43%) or propofol alone (17, 33%) being preferred to ketamine (6, 11%). Propofol is a GABAA-receptor-positive allosteric modulator and primarily causes sedation, with no analgesic properties, and is therefore not typically used as the sole agent for ED PSA [38]. Pre-PSA medications such as analgesia are written on a medication chart, and these are not entered into the PSA registry. We therefore postulate that patients who received propofol as a sole agent for their PSA were likely to have been judged by the treating clinician to have had adequate pre-PSA treatment.
Patient disposition following ED PSA in the adult population was also different, with the majority (17, 47%) being admitted to the ward compared with the pediatric population (2, 14%). This is not surprising given that injuries in adults requiring procedural sedation are more likely to require definitive management in the operating theater [13]. The third most common disposition for adults was the short-stay unit (8, 22%).

4.3. ED PSA Safety Profile

The first 3 months of consecutive PSA induction in our registry showed very few complications. This included 4 out of 56 cases (7%) reported to have desaturations, 2 out of 45 cases (6%) reporting episodes of hemodynamic instability, and none with significant sequelae. This aligns with the literature, where a systematic review by Bellolio et al. found that the most common complications for ED PSA included hypoxia (40.2 per 1000 cases), vomiting (16.4 per 1000 cases), and hypotension (15.2 per 1000 cases) [19]. Our cohort was reassuringly free from severe adverse events requiring emergent medical intervention given that the incidence has been reported to be rare. This included aspiration (1.2 per 1000 cases), laryngospasm (4.2 in 1000), and intubation (1.6 per 1000 cases) [19,20,24]. A larger patient cohort is required to determine if our ED aligns with these benchmarks. Based on the frequency of PSA induction over this 3-month period, it would require 3 years to reach the 1000 cases required to determine this.
Patient selection, including an understanding of risk factors and exclusion criteria for performing an ED PSA, influences the safety profile and outcomes [9]. For our cohort, 42 (93%) patients had a normal pre-procedural physiological status recorded and 3 (8%) identified prior anesthetic complications, allowing anticipation and mitigation of these patients within the ED PSA approach. Since one of the most severe adverse events is the loss of airway patency, airway assessment is critical for patient selection for ED PSA [9]. In our cohort, a structured airway assessment was performed in 93% (67 out of a total of 72) of cases, of which 1 (2%) (1 out of a total of 60) was predicted to be difficult.
The merits of fasting prior to sedation are extrapolated from elective general anesthetic approaches, with studies now showing that fasting for any duration has not demonstrated a reduction in the risk of emesis or aspiration when administering PSA in the ED [23,39]. Fasting status was documented in 48 (60%) PSA instances, with a fasting status of both less than 6 h and 6 h or more reported in 24 (50%) cases each. The significance of this is unclear given that the rate of aspiration is reported to be 1.2 per 1000 cases [39].
The safety of ED PSA is also determined by the experience of the clinician team leader [2,13]. Our data show a lower tolerance for risk reflected by the presence of more senior clinicians for pediatric ED PSA, with 15 (75%) team leaders identified as specialist compared with 16 (60%) in the adult cohort. The level of seniority also explains some of the diurnal patterns seen for ED PSA. In our study, ED PSA was induced most frequently at 0900–1000 (9 PSA inductions) with sustained procedures between 1000 and 2300 (mean 0.04 PSA inductions per hour) and reduced procedures between 0000 and 0800 (mean 0.01 PSA inductions per hour). The reduction after 0000 is likely explained by both the absence of an on-site specialist between 0030 and 0700, as well as reduced patient presentations (and therefore a reduced incidence of injuries or other indications requiring ED PSA) [40]. The spike in ED PSA activity at 0900–1000 is also explained by the safety culture in our department, which involves ensuring there are adequate medical and nursing staffing to safely induce ED PSA and therefore delaying ED PSA induction until the morning.

4.4. ED PSA Documentation

Despite documentation occurring via a paper-based form in our ED, the documentation of various aspects of the form was widely variable. The most documented section was pharmacological (78, 99%), and least documented was prior anesthetic complications (40, 50%). Co-morbidities (44, 55%) and pre-procedural physiological status (45, 56%) were also poorly documented. Variability in documentation for the various elements of a PSA was also reported by Veen et al., who reviewed PSA for hip dislocation and found documentation of fasting status, airway screening, analgesia and vital signs to be 64.9%, 80.3%, 37.4%, and 72.7% complete, respectively [41]. We postulate that these parameters may be either due to time-critical circumstances or other higher priorities within the ED setting or due to not being considered important to the procedural clinician. Future analysis of the data capturing tool in conjunction with clinicians will help to understand and refine the tool to ensure appropriate data are captured with a higher completion rate.

5. Limitations

The main limitation to this study is the retrospective nature of the methodology. A combination of ambiguous documentation may skew the results that were able to be collected. As the procedural sedation collection tool used in our department is also used as the medical record, observation chart, and medication chart, almost all PSA instances will be captured in our ED. On occasion, the doctor may prescribe medications in the medication chart and record their pre-PSA assessment in the medical record rather than use the form. Since the PSA form also acts as a memory aid to risk assess patients undergoing PSA, clinicians who do not use the form may have an increased harm profile when inducing PSA that will not be captured. Another limitation was that we did not include patients who were considered for a PSA but were deemed unsuitable prior to an ED PSA form (including formal risk assessment) being completed. Our study was also a single-center study in a mixed ED and this therefore limited its ability to be a representative sample. Finally, a significant limitation of the research study is the short time frame of three months, which may not be sufficient to observe long-term effects or trends. This limited duration could result in incomplete data, potentially affecting the reliability and validity of the findings. Additionally, the short time frame may not allow for the consideration of seasonal variations or other time-dependent factors that could influence the results.

6. Conclusions

A review of the first 3 months of consecutive PSA instances captured in our registry found that PSA was performed in our tertiary mixed ED at a rate just under 1 per day if the distribution was normal. ED PSA is also both safe and effective, with non-severe complication rates similar to those in the reported literature despite changes in the ED environment over the last decade. Severe complications are rare and therefore a larger cohort will be required to assess this concern. The approach to ED PSA is different between pediatric and adult populations and therefore research needs to differentiate between both populations. Documentation remains universally poor and the reasons why need to be explored further.

Author Contributions

Conceptualization, V.T. and G.B.; methodology, V.T. and G.B.; analysis, V.T. and G.B.; investigation, V.T., G.B., J.W. and N.A.; writing—original draft preparation, V.T., G.B., J.W. and N.A.; writing—review and editing, V.T., G.B., J.W. and N.A.; visualization, V.T. and G.B.; supervision, V.T.; project administration, G.B. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Ethics approval has been provided by Tasmania Health and Medical Human Research Ethics Committee on 15 March 2021, HREC24024. Department of Health Research Governance Office Approval has also been obtained on 31 May 2023, SSA453.

Informed Consent Statement

Patient consent was waived as this was a retrospective review of routinely collected data and ethically approved in this manner.

Data Availability Statement

The data presented in this study are available on request from the corresponding author. The data are not publicly available due to ethical review board requirements.

Acknowledgments

We also acknowledge the Tasmanian Health Service who has supported this research.

Conflicts of Interest

The authors declare no conflicts of interest.

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Anesthres 01 00015 g001
Figure 1. Frequency of PSA cases per hour of day over a 3-month period (total PSA cases = 80).
Figure 1. Frequency of PSA cases per hour of day over a 3-month period (total PSA cases = 80).
Anesthres 01 00015 g001
Table 1. Population characteristics of the first 3 months of procedural sedation records.
Table 1. Population characteristics of the first 3 months of procedural sedation records.
Demographics<14 Years14 Years and AboveTotal
Gender n, (%)
Male18 (64)28 (54)46 (58)
Female10 (36)24 (46)34 (42)
Total285280
Age
Mean (years ± SD) 6.9 (4.3)48.8 (23.4)34.2 (27.6)
Range (Min–Max) 0–1415–890–89
1st and 3rd quartile (IQR) 3.0–10.0 (7.0)26.5–70.5 (44.0)10.0–61.0 (51.0)
Table 2. Non-documentation of ED PSA.
Table 2. Non-documentation of ED PSA.
Variable<14 Years
n (%)		14 Years and Above
n (%)		Total
n (%)
Team leader specialty 7 (25)25 (48)32 (40)
Indication 3 (11)8 (15)11 (14)
Co-morbidities8 (28)28 (54)36 (45)
Pre-procedure physiology8 (28)27 (52)35 (44)
Prior anesthetic complications9 (32)31 (60)40 (50)
ASA 110 (36)16 (31)26 (32)
Structured airway assessment3 (11)5 (10)8 (10)
Predicted Difficult Airway 9 (32)11 (21)20 (25)
Hours fasted 16 (57)16 (31)32 (40)
Pharmacologic 1 (4)1 (2)2 (2)
Disposition 14 (50)16 (31)30 (38)
1 American Society of Anesthesiology physical status.
Table 3. Measured PSA variables.
Table 3. Measured PSA variables.
Variable<14 Years,
n (%)		14 Years and Above, n (%)Total, n (%)
Team Leader Specialty
Anesthetics department1 (5)0 (0)1 (2)
Emergency department (total)20 (95)27 (100)47 (98)
Specialist15 (75)16 (60)31 (66)
Registrar5 (25)11 (40)16 (33)
Total212748
Indication
Joint reduction 2 (8)17 (39)19 (27)
Fracture reduction 9 (36) 13 (29)22 (32)
Laceration repair 7 (28)1 (2)8 (12)
Cardioversion-11 (25)11 (16)
Other distressing procedure7 (28)2 (5)9 (13)
Total254469
Co-morbidities
014 (70)13 (54)27 (62)
1–26 (30)10 (42)16 (36)
3–5---
>5-1 (4)1 (2)
Total202444
Pre-Procedure Physiological Status
Normal 20 (100)22 (88)42 (93)
Abnormal-3 (12)3 (7)
Total202545
Prior Anesthetic Complications
Yes2 (10)1 (5)3 (8)
No17 (90)20 (95)37 (92)
Total192140
ASA 1
115 (83)20 (56)35 (65)
23 (17)11 (30)14 (26)
3-4 (11)4 (7)
4-1 (3)1 (2)
5---
Total183654
Structured Airway Assessment
Yes23 (92)44 (94)67 (93)
No2 (8) 3 (6)5 (7)
Total254772
Predicted Difficult Airway
Yes0 (0)1 (3)1 (2)
No19 (100)40 (97)59 (98)
Total194160
Fasting Status
≤6 h7 (58)17 (47)24 (50)
6 h or more5 (42)19 (53)24 (50)
Total123648
Medication(s) prescriptions
Ketamine 25 (92)6 (12)31 (40)
Ketamine, propofol and fentanyl -1 (2)1 (1)
Ketamine, fentanyl and midazolam-1 (2)1 (1)
Propofol1 (4)17 (33)18 (24)
Propofol and local anesthetic 1 (4)-1 (1)
Propofol and fentanyl -22 (43)22 (29)
Propofol, fentanyl and midazolam-1 (2)1 (1)
Midazolam and fentanyl -1 (2)1 (1)
Midazolam and droperidol-1 (2)1 (1)
Morphine and propofol-1 (2)1 (1)
Total275178
Complications
Airway compromise
  Yes000 (0)
  No17 (100)38 (100)55 (100)
Desaturation
  Yes04 (10)4 (7)
  No17 (100)35 (90)52 (93)
Hemodynamic instability
  Yes02 (6)2 (4)
  No13 (100)32 (94)45 (96)
Total066
Disposition
Usual place of residence 11 (79)10 (28)21 (42)
ED short-stay unit1 (7)8 (22)9 (18)
Inpatient ward2 (14)17 (47)19 (38)
Operating theater-1 (3)1 (2)
Total143650
1 American Society of Anesthesiology physical status.
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MDPI and ACS Style

Tran, V.; Whitfield, J.; Askaroff, N.; Barrington, G. Procedural Sedation and Analgesia in an Australian Emergency Department: Results of the First 3 Months of a Procedural Sedation Registry. Anesth. Res. 2024, 1, 157-167. https://doi.org/10.3390/anesthres1030015

AMA Style

Tran V, Whitfield J, Askaroff N, Barrington G. Procedural Sedation and Analgesia in an Australian Emergency Department: Results of the First 3 Months of a Procedural Sedation Registry. Anesthesia Research. 2024; 1(3):157-167. https://doi.org/10.3390/anesthres1030015

Chicago/Turabian Style

Tran, Viet, James Whitfield, Natasha Askaroff, and Giles Barrington. 2024. "Procedural Sedation and Analgesia in an Australian Emergency Department: Results of the First 3 Months of a Procedural Sedation Registry" Anesthesia Research 1, no. 3: 157-167. https://doi.org/10.3390/anesthres1030015

APA Style

Tran, V., Whitfield, J., Askaroff, N., & Barrington, G. (2024). Procedural Sedation and Analgesia in an Australian Emergency Department: Results of the First 3 Months of a Procedural Sedation Registry. Anesthesia Research, 1(3), 157-167. https://doi.org/10.3390/anesthres1030015

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