title: Procedural sedation and analgesia in a Canadian adult tertiary care emergency department: a case series.
abstract: OBJECTIVE
  To examine the safety of emergency department (ED) procedural sedation and analgesia (PSA) and the patterns of use of pharmacologic agents at a Canadian adult teaching hospital.
  
  
  METHODS
  Retrospective analysis of the PSA records of 979 patients, treated between Aug. 1, 2004, and July 31, 2005, with descriptive statistical analysis. This represents an inclusive consecutive case series of all PSAs performed during the study period.
  
  
  RESULTS
  Hypotension (systolic blood pressure < or = 85 mm Hg) was documented during PSA in 13 of 979 patients (1.3%; 95% confidence interval [CI] 0.3%-2.3%), and desaturation (SaO2 < or = 90) in 14 of 979 (1.4%; Cl 0.1%-2.7%). No cases of aspiration, endotracheal intubation or death were recorded. The most common medication used was fentanyl (94.0% of cases), followed by propofol (61.2%), midazolam (42.5%) and then ketamine (2.7%). The most frequently used 2-medication combinations were propofol and fentanyl (P/F) followed by midazolam and fentanyl (M/F), used with similar frequencies 58.1% (569/979) and 41.0% (401/979) respectively. There was no significant difference in the incidence of hypotension or desaturation between the P/F and M/F treated groups. In these patients, 9.1% (90/979) of patients received more than 2 different drugs.
  
  
  CONCLUSIONS
  Adverse events during ED PSA are rare and of doubtful clinical significance. Propofol/fentanyl and midazolam/fentanyl are used safely, and at similar frequencies for ED PSA in this tertiary hospital case series. The use of ketamine for adult PSA is unusual in our facility.
authors.affiliation: Department of Emergency Medicine, Dalhousie University, Halifax, NS. Samuel.Campbell@CDHA.nshealth.ca
authors.forename: Sam G
authors.initials: SG
authors.lastname: Campbell
authors.forename: Kirk D
authors.initials: KD
authors.lastname: Magee
authors.forename: George J
authors.initials: GJ
authors.lastname: Kovacs
authors.forename: David A
authors.initials: DA
authors.lastname: Petrie
authors.forename: John M
authors.initials: JM
authors.lastname: Tallon
authors.forename: Robert
authors.initials: R
authors.lastname: McKinley
authors.forename: David G
authors.initials: DG
authors.lastname: Urquhart
authors.forename: Linda
authors.initials: L
authors.lastname: Hutchins
mesh_terms: D017677:Age Distribution; D000368:Aged; D002170:Canada; D016292:Procedural Sedation / Q000379:methods*; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006784:Hospitals, Teaching; 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; D015742:Propofol / Q000627:therapeutic use; D012189:Retrospective Studies; D017678:Sex Distribution
chemical_list: D006993:Hypnotics and Sedatives; D007649:Ketamine; D008874:Midazolam; D010100:Oxygen; D005283:Fentanyl; D015742:Propofol