title: Procedural sedation practices in Australian Emergency Departments.
abstract: OBJECTIVE
  The aim of the present study was to describe procedural sedation practices undertaken in a spectrum of Australian EDs.
  
  
  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 used a specifically designed data collection document.
  
  
  RESULTS
  2623 patients were enrolled. 1581 were male (60.3%, 95% CI 58.4-62.2) and the mean patient age was 39.2 (SD 25.2) years. Reductions of fracture/dislocated shoulders (694 cases, 26.7%), wrist/forearm fractures (403, 15.5%) and tibia/fibula fractures (341, 13.1%) were the most common procedures. Procedures were supervised by consultants and registrars in 1424 (54.3%) and 1025 (39.1%) cases, respectively. Of 2413 patients with complete fasting status data, 1252 (51.9%, 95% CI 49.9-53.9) patients had consumed food or fluid in the previous 6 h. 1399 (53.3%, 95% CI 51.4-55.3) patients received pre-procedural medication. Pre-procedural morphine (894, 34.1%) exceeded fentanyl use (323, 12.3%), both as a sole agent and in combination with another agent. The principal sedatives used alone were propofol (857, 38.5%), midazolam (224, 10%) and ketamine (165, 7.4%). Ketamine and nitrous oxide were most commonly used in children with propofol, midazolam and opiates largely restricted to adults (P < 0.001). The intra-procedural use of adjunct fentanyl exceeded that of morphine (ratio 4:1).
  
  
  CONCLUSIONS
  Procedural sedation practice across Australian EDs is varies considerably. Procedural sedation 'best practice' guidelines, based upon the findings of the present study and the available evidence, are recommended.
authors.affiliation: Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia.
authors.forename: Anthony
authors.initials: A
authors.lastname: Bell
authors.forename: David McD
authors.initials: DM
authors.lastname: Taylor
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: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D010818:Practice Patterns, Physicians'; D011300:Preoperative Care; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives