title: Inadequate provision of postintubation anxiolysis and analgesia in the ED.
abstract: BACKGROUND
  Patients intubated in the emergency department (ED) often have extended ED stays. We hypothesize that ED intubated patients receive inadequate postintubation anxiolysis and analgesia after rapid sequence induction (RSI).
  
  
  METHODS
  This was a retrospective cohort study of every adult intubated in a tertiary-care ED (July 2003-June 2004). Patients were included if they underwent RSI, remained in the ED for more than 30 minutes post intubation, and survived to admission. Presuming a mean patient weight of 70 kg, we defined adequacy of anxiolysis and analgesia on the provision postintubation of weight-based doses of lorazepam (0.77 mg/h) or midazolam (4.2 mg/h) and fentanyl (35 microg/h), referenced from pharmaceutical texts. Demographic data, time in ED, and dosage of each medication given were abstracted. The proportion, with 95% confidence intervals (CIs), of patients receiving inadequate anxiolysis and analgesia were computed.
  
  
  RESULTS
  One hundred seventeen patients met the inclusion criteria. Mean time in the ED was 4.2 hours (SD +/- 3.1 hours). Thirty-nine patients received no anxiolytic (33%, CI 25%-43%), and 62 received no analgesic (53%, CI 44%-62%). Twenty-three patients received neither anxiolytic nor analgesic (20%, CI 13%-28%). Of 70 patients given postintubation vecuronium, 67 received either no or inadequate anxiolysis or analgesia (96%, CI 87%-99%). Overall, 87 of 117 patients received no or inadequate anxiolysis (74%, CI 65%-82%); and 88 of 117 received no or inadequate analgesia (75%, CI 66%-83%).
  
  
  CONCLUSIONS
  Patients undergoing RSI in the ED frequently receive inadequate postintubation anxiolysis and analgesia.
authors.affiliation: Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0769, USA.
authors.forename: Jordan B
authors.initials: JB
authors.lastname: Bonomo
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Butler
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lindsell
authors.forename: Arvind
authors.initials: A
authors.lastname: Venkat
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D014151:Anti-Anxiety Agents / Q000008:administration & dosage*; D001007:Anxiety / Q000188:drug therapy* / Q000209:etiology; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000523:psychology; D008140:Lorazepam / Q000008:administration & dosage; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D014151:Anti-Anxiety Agents; D006993:Hypnotics and Sedatives; D008140:Lorazepam; D008874:Midazolam; D005283:Fentanyl