Procedural sedation in the emergency department

Procedural sedation in the emergency department is performed successfully across the country by many emergency medicine physicians. There are many varied styles of sedation in the ED that may vary from hospital to hospital. The required equipment, presences of additional providers, etc may vary slightly depending on the emergency department and its staffing complements. In addition, there are a variety of sedatives that may be used for sedation in the ED. Among the most common are ketamine and propofol, etomidate, and fentanyl/versed. Dexmedetomidine and remifentanyl remain on the horizon. Both the sedation practice and the need for the ED physician to also perform the procedure himself/herself make the style and technique of procedural sedation in the ED unique. It many ways it is very different from elsewhere in the hospital. However, the emergency medicine physician still maintains a high standard of care and a high quality safety margin. At all times there should be emergency airway equipment available. Also, an assessment of the urgency of the procedure is made by the ED physician. NPO status is less of a highlighted issue. In most all settings, it is also highly recommended that supplemental oxygen and capnography be used. The physician performing the sedation must be competent in emergency airway techniques.