Emergency department procedural sedation and analgesia: A Canadian Community Effectiveness and Safety Study (ACCESS).
OBJECTIVE
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 > or = 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. I the 64% of cases where capnometry was used, there was no association between its use and any AE measures.


CONCLUSIONS
Procedural sedation was safe and effective in our environment. Capnometry recording did not appear to alter outcomes, although the data are incomplete.
Mensour
Mark
M
Department of Emergency Medicine, Northern Ontario School of Medicine, East Campus, Sudbury, ON. mensours@cogeco.ca
Pineau
Robert
R
Sahai
Vic
V
Michaud
Jennifer
J
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001049:Apnea / Q000139:chemically induced; D001785:Blood Gas Monitoring, Transcutaneous / Q000706:statistics & numerical data; D001919:Bradycardia / Q000139:chemically induced; D002170:Canada; D002648:Child; D016292:Procedural Sedation / Q000379:methods* / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005045:Etomidate / Q000627:therapeutic use; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006764:Hospitals, Community; D006780:Hospitals, Rural; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007022:Hypotension / Q000139:chemically induced; D007649:Ketamine / Q000627:therapeutic use; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D010100:Oxygen / Q000097:blood; D010821:Physicians, Family; D015742:Propofol / Q000627:therapeutic use; D011446:Prospective Studies
D006993:Hypnotics and Sedatives; D007649:Ketamine; D008874:Midazolam; D010100:Oxygen; D005283:Fentanyl; D015742:Propofol; D005045:Etomidate