title: Recall after procedural sedation in the emergency department.
abstract: BACKGROUND
  Procedural sedation (PS) is common in the emergency department (ED) and ideally patients should have no recall of the procedure.
  
  
  OBJECTIVE
  To determine the incidence of recall.
  
  
  METHODS
  A prospective observational study in an university ED of all patients undergoing PS. Data were collected on a pre-formatted data sheet. Levels of satisfaction with the sedation by the treating physician and nurse were recorded on a 10 cm visual analogue scale. On recovery, the patient was asked a validated questionnaire to determine the rate of immediate recall and at telephone follow-up for delayed recall.
  
  
  RESULTS
  125 patients (88 male, 70%) were enrolled and 110 had completed follow-up. Mean (range) age was 51.6 (13-91) years. Procedures included 84 (67%) orthopaedic reductions and 41 (33%) cardioversions. A wide range of drug combinations were used, including fentanyl/propofol 32 (25.6%), fentanyl/midazolam 30 (24%), fentanyl/midazolam/propofol 16 (12.8%), propofol 13 (10.4%). 87.2% of procedures were successful. A grimace/groan was observed in 61 of 125 (49%). Immediate recall occurred in 9 of 121 (7.4%; 95% CI 3.7 to 14.0) and delayed recall in 5 of 110 (4.5%; 95% CI 1.7 to 10.8). No drug combination was correlated with recall (Spearman's rho = 0.149), nor the presence of a grimace/groan (r = -0.039). Median sedation satisfaction scores were physician 9.0, nurse 10, patient 10. Correlation of delayed recall with patient satisfaction was -0.471 (p<0.001).
  
  
  CONCLUSIONS
  Recall following PS in ED is uncommon. There is no association of recall with drugs used or the presence of a grimace/groan. There is high patient satisfaction with PS in the ED.
authors: Department of Anaesthesia, Royal Perth Hospital, Perth, WA, Australia. alexswann@doctors.org.uk
authors: Alex
authors: A
authors: Swann
authors: Jeffrey
authors: J
authors: Williams
authors: Daniel M
authors: DM
authors: Fatovich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D016292:Procedural Sedation / Q000706:statistics & numerical data*; D004325:Dreams / Q000187:drug effects; D004359:Drug Therapy, Combination; D004554:Electric Countershock / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D019637:Orthopedic Procedures / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011446:Prospective Studies; D014904:Western Australia / Q000453:epidemiology
chemical_list: D018686:Anesthetics, Intravenous; D009294:Narcotics