Preprocedural Fasting State and Adverse Events in Children Receiving Nitrous Oxide for Procedural Sedation and Analgesia

2005 ◽  
Vol 21 (11) ◽  
pp. 736-743 ◽  
Author(s):  
Franz E. Babl ◽  
Ardita Puspitadewi ◽  
Peter Barnett ◽  
Ed Oakley ◽  
Maureen Spicer
Keyword(s):  
Nitrous Oxide ◽  
Adverse Events ◽  
Procedural Sedation ◽  
Fasting State ◽  
Procedural Sedation And Analgesia ◽  
Sedation And Analgesia

scholarly journals Does the sedation regimen affect adverse events during procedural sedation and analgesia in injection drug users?

CJEM ◽  
2013 ◽  
Vol 15 (05) ◽  
pp. 279-288 ◽  
Author(s):  
Frank Xavier Scheuermeyer ◽  
Gary Andolfatto ◽  
Hong Qian ◽  
Eric Grafstein
Keyword(s):  
Adverse Events ◽  
Injection Drug Users ◽  
Drug Users ◽  
Vital Signs ◽  
Injection Drug ◽  
Procedural Sedation ◽  
Secondary Outcome ◽  
Procedural Sedation And Analgesia ◽  
Pearson Coefficient ◽  
Sedation And Analgesia

ABSTRACT Objectives: Injection drug users (IDUs) often undergo procedural sedation and analgesia (PSA) as part of emergency department (ED) treatment. We compared adverse events (AEs) using a variety of sedation regimens. Methods: This was a retrospective analysis of a PSA safety audit in two urban EDs. Consecutive self-reported IDUs were identified, and structured data describing comorbidities, vital signs, sedation regimens (propofol [P], propofol-fentanyl [PF], fentanyl-midazolam [FM], ketofol [1:1 ketamine:propofol, KF], and ketamine-propofol [KP]) and AEs were collected. The primary outcome was the proportion of patients in each sedation group having an AE; the secondary outcome was the proportion of patients having a cardiovascular or respiratory AE. Results: Data were collected on 276 IDUs (78 P, 82 PF, 65 FM, 25 KF, and 26 KP), and 18 patients had AEs (6.5%, 95% CI 4.0–10.3). The AE rates were 0.0%, 8.5%, 9.2%, 12.0%, and 7.6%, respectively, with propofol having a significantly lower rate (Pearson coefficient 14.9, p = 0.007). The cardiovascular/respiratory AE rates were significantly different as well, with P, KP, and KF having the lowest rates (Pearson coefficient 13.3, p = 0.01). Conclusions: For IDU PSA, the overall AE rate was 6.5%, and propofol appeared to have a significantly lower rate.

scholarly journals Guidelines for the safe use of procedural sedation and analgesia for diagnostic and therapeutic procedures in adults: 2020–2025

2020 ◽  
pp. S1-S75
Author(s):  
J Roelofse ◽  
M Jansen van Rensburg
Keyword(s):  
Adverse Events ◽  
Clinical Training ◽  
Blood Pressure Monitoring ◽  
Healthcare Providers ◽  
Operating Theatre ◽  
Procedural Sedation ◽  
International Level ◽  
Procedural Sedation And Analgesia ◽  
Record Keeping ◽  
Sedation And Analgesia

Writing guidelines on procedural sedation and analgesia is a formidable and challenging task. There are many disciplines and societies at international level now involved in writing guidelines and we need to be aware of what they see as important in their guidelines. We always need to identify new trends in sedation; for that we need to be involved at international level. Our aim with these guidelines is to provide a guidance for safe sedation practice for all healthcare providers who are involved in sedation practice. In this issue we have added adverse events and record-keeping, accreditation and the importance of simulation training to our recommendations under clinical governance. We would like our sedation practitioners to keep records and report adverse events to our societies, e.g. SOSPOSA, so that we all can benefit from the information we get. It is also crucial that sedation practitioners keep their logbooks and update them regularly – “if it is not written down, it never happened”. All aspects of accreditation remain an important issue and we need to address this urgently. This forms an important part of safe sedation practice, also done at international level, and we need to follow this. The facilities where we work, especially outside the operating theatre, must meet the requirements for safe practice. It is our responsibility to see that this is the case. In the appendices there is a practice appraisal protocol that should be filled in by sedation practitioners doing sedation outside the operating theatre. We do not cover sedation techniques in the guidelines. We believe sedation practitioners must learn the techniques with supervised clinical training. Capnography for sedation outside the operating theatre will become a focus point in future. We are only supposed to be doing ASA I and II patients outside the operating theatre so there may be a feeling we do not need capnography. There is pressure to include capnography under monitoring as a minimum monitoring standard, like pulse oximetry and blood pressure monitoring. Our appendices have been revised with more information on what patients need to know about sedation e.g. an example of a cover letter to the patient. This will include information to the patient, as well as information from the patient. Sedation is today one of the fastest growing areas in anaesthesia care. Our research studies show a low incidence of side-effects, and a high incidence of patient satisfaction. To all our readers we wish you a safe sedation journey.

scholarly journals Do injection drug users have more adverse events during procedural sedation and analgesia for incision and drainage of cutaneous abscesses?

CJEM ◽  
2013 ◽  
Vol 15 (02) ◽  
pp. 90-100
Author(s):  
Frank Xavier Scheuermeyer ◽  
Gary Andolfatto ◽  
Lisa Lange ◽  
Danielle de Jong ◽  
Hong Qian ◽  
...  
Keyword(s):  
Adverse Events ◽  
Injection Drug Users ◽  
Drug Users ◽  
Vital Signs ◽  
Injection Drug ◽  
Procedural Sedation ◽  
Incision And Drainage ◽  
Procedural Sedation And Analgesia ◽  
Recovery Times ◽  
Sedation And Analgesia

ABSTRACT Objective: Injection drug users (IDUs) often undergo procedural sedation and analgesia (PSA) in the emergency department (ED). We compared adverse events (AEs) for IDUs to those for non-IDUs receiving PSA for incision and drainage of cutaneous abscesses. Methods: This was a retrospective analysis of a PSA safety audit. IDU status was prospectively documented among consecutive patients undergoing PSA at two urban EDs. Structured data describing comorbidities, vital signs, sedation regimens, and adverse events were collected. Primary outcome was the proportion of patients in each group experiencing an AE, whereas the secondary outcomes included recovery times. Results: Of 525 consecutive patients receiving PSA for incision and drainage of an abscess, 244 were deemed IDUs and 281 non-IDUs. IDUs received higher doses of sedatives and analgesics, and 14 experienced AEs (5.7%), whereas 10 non-IDUs had AEs (3.6%), for a risk difference of 2.1% (95% CI -1.8, 6.5). Median recovery times were 18 minutes (interquartile range [IQR] 10-36) for IDUs and 12 minutes (IQR 7-19) for non-IDUs, for a difference of 6 minutes (95% CI 2-9 minutes). Median sedation times were also longer in IDUs, for a difference of 6 minutes (95% CI 5-10 minutes). Of 20 IDU patients and 1 non-IDU patient admitted to hospital, none had experienced an AE related to PSA. Conclusions: For ED patients requiring PSA for incision and drainage, IDUs had an AE rate similar to that of non-IDUs but longer sedation and recovery times. In experienced hands, PSA may be as safe in IDUs as in patients who do not use injection drugs.

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