title: Factors associated with failure to successfully complete a procedure during emergency department sedation.
abstract: OBJECTIVE
  To determine factors associated with failure to successfully complete a procedure during sedation in the ED.
  
  
  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 and the success or failure of the procedure was recorded.
  
  
  RESULTS
  Data were available for 2567 patients. Of these, 1548 (60.3%, 95% CI 58.4-62.2) were male and 456 (17.8%, 95% CI 16.3-19.3) were age <16 years. The most common procedures performed were reduction of major joints and laceration repair. A total of 149 procedures (5.8%, 95% CI 5.0-6.8) failed. There were significant differences in failure rates between the types of procedure undertaken, with reduction of hips, digits and mandibles associated with the highest failure rates (P < 0.001). In adults, body weight >100 kg was also associated with increased risk of procedural failure (odds ratio 2.3, 95% CI 1.3-4.1). Ketamine used as a single agent had the lowest procedural failure rate (2.5%, 95% CI 1.1-5.4) whereas propofol had the highest (5.9%, 95% CI 4.6-7.6). However, these two drugs were generally used in different age groups and for different procedures.
  
  
  CONCLUSIONS
  Procedures performed under sedation in the ED have a low failure rate. However, increased body weight and specific procedures, such as hip reduction, are associated with significantly higher failure rates. Special consideration should be given to these patient groups before undertaking sedation in the ED.
authors.affiliation: Liverpool Hospital, Sydney, New South Wales, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: Holdgate
authors.forename: David McD
authors.initials: DM
authors.lastname: Taylor
authors.forename: Anthony
authors.initials: A
authors.lastname: Bell
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: D000293:Adolescent; D000328:Adult; D001315:Australia; D016292:Procedural Sedation / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D017211:Treatment Failure; D055815:Young Adult