Pharmacology of emergency department pain management and conscious sedation.
The endpoints of sedation and analgesia have been more difficult than traditional physiologic parameters to measure adequately. Several clinical scoring systems have been developed in an attempt to provide more consistent and objective assessments of sedation, but the few that have been validated are cumbersome to use in the clinical setting and cannot accurately determine subtle changes in the level of sedation. Recent developments in EEG monitoring, particularly one using bispectral (BIS) analysis of the EEG signal obtained through a noninvasive forehead "lead," are promising. BIS monitoring has been used as a reliable measure of depth of midazolam-induced sedation during general anesthesia. Anesthesiologists have used this technology to prevent awareness during paralysis. One recently completed but as yet unpublished study in the ED demonstrated a high correlation with traditional sedation scales and found the device easy to use (UNC Hospitals Department of Emergency Medicine, personal communication, 1999). It is anticipated that with BIS monitoring, in combination with titratable, short-acting agents, appropriate levels of sedation can be more easily achieved while minimizing associated complications and duration of ED stay.
Blackburn
P
P
Department of Emergency Medicine, Maricopa Medical Center, Phoenix, Arizona, USA.
Vissers
R
R
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D016292:Procedural Sedation; D004635:Emergency Medicine / Q000379:methods*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D009294:Narcotics / Q000009:adverse effects / Q000627:therapeutic use*; D009609:Nitrous Oxide / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy*
D000305:Adrenal Cortex Hormones; D000700:Analgesics; D018712:Analgesics, Non-Narcotic; D006993:Hypnotics and Sedatives; D009294:Narcotics; D009609:Nitrous Oxide