title: Risk factors for sedation-related events during procedural sedation in the emergency department.
abstract: OBJECTIVE
  To determine the nature, incidence and risk factors for sedation-related events during ED procedural sedation, with particular focus on the drugs administered.
  
  
  METHODS
  Eleven Australian EDs enrolled consecutive adult and paediatric patients between January 2006 and December 2008. Patients were included if a sedative drug was administered for an ED procedure. Data collection was prospective and employed a specifically designed form. Multivariate logistic regression was employed to determine risk factors for sedation-related events.
  
  
  RESULTS
  Two thousand, six hundred and twenty-three patients were enrolled (60.3% male, mean age 39.2 years). Reductions of fracture/dislocations of shoulders, wrists and ankles were most common. Four hundred and sixty-one (17.6%) cases experienced at least one airway event that required intervention. Airway obstruction, hypoventilation and desaturation occurred in 12.7%, 6.4% and 3.7% of all patients, respectively. Two thousand, one hundred and forty-six cases had complete datasets for further analyses. Increasing age and level of sedation, pre-medication with fentanyl, and sedation with propofol, midazolam or fentanyl were risk factors for an airway event (P < 0.05). Ketamine was a protective factor. Hypotension (systolic pressure <80 mmHg) occurred in 34 (1.6%) cases with midazolam being a significant risk factor (P < 0.001). Vomiting also occurred in 34 (1.6%) cases, 12 of whom required an intervention. One patient aspirated. Vomiting occurred after administration of all drugs but was not associated with fasting status. Other events were rare.
  
  
  CONCLUSIONS
  Sedation-related events, especially airway events, are common but very rarely have an adverse outcome. Elderly patients, deeply sedated with short-acting agents, are at particular risk. The results will help tailor sedation to individual patients.
authors.affiliation: Austin Hospital, Melbourne, Victoria, Australia. david.taylor@austin.org.au
authors.forename: David McD
authors.initials: DM
authors.lastname: Taylor
authors.forename: Anthony
authors.initials: A
authors.lastname: Bell
authors.forename: Anna
authors.initials: A
authors.lastname: Holdgate
authors.forename: Catherine
authors.initials: C
authors.lastname: MacBean
authors.forename: Truc
authors.initials: T
authors.lastname: Huynh
authors.forename: Ogilvie
authors.initials: O
authors.lastname: Thom
authors.forename: Michael
authors.initials: M
authors.lastname: Augello
authors.forename: Robert
authors.initials: R
authors.lastname: Millar
authors.forename: Robert
authors.initials: R
authors.lastname: Day
authors.forename: Aled
authors.initials: A
authors.lastname: Williams
authors.forename: Peter
authors.initials: P
authors.lastname: Ritchie
authors.forename: John
authors.initials: J
authors.lastname: Pasco
mesh_terms: D000328:Adult; D000367:Age Factors; D001315:Australia / Q000453:epidemiology; D016292:Procedural Sedation / Q000009:adverse effects*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D007022:Hypotension / Q000139:chemically induced / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012120:Respiration Disorders / Q000139:chemically induced / Q000453:epidemiology; D012307:Risk Factors; D014839:Vomiting / Q000139:chemically induced / Q000453:epidemiology; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives