title: Procedural sedation in the emergency department by Dutch emergency physicians: a prospective multicentre observational study of 1711 adults.
abstract: OBJECTIVE
  To describe our experience performing ED procedural sedation in a country where emergency medicine (EM) is a relatively new specialty.
  
  
  METHODS
  This is a prospective observational study of adult patients undergoing procedural sedation by emergency physicians (EPs) or EM residents in eight hospitals in the Netherlands. Data were collected on a standardised form, including patient characteristics, sedative and analgesic used, procedural success, adverse events (classified according to World SIVA) and rescue interventions.
  
  
  RESULTS
  1711 adult cases were included from 2006 to 2013. Propofol, midazolam and esketamine (S+ enantiomer of ketamine) were the most used sedatives (63%, 29% and 8%). We had adverse event data on all patients. The overall adverse event rate was 11%, mostly hypoxia or apnoea. There was no difference in adverse event rate between EPs and EM residents. However, there was a significantly higher success rate of the procedure when EPs did the procedural sedation (92% vs 84%). No moderate (unplanned hospital admission or escalation of care) or sentinel SIVA outcomes occurred (pulmonary aspiration syndrome, death or permanent neurological deficit).
  
  
  CONCLUSIONS
  Adverse events during procedural sedation occurred in 11% of patients. There were no moderate or sentinel outcomes. All events could be managed by the sedating physician. In a country where EM is a relatively new specialty, procedural sedation appears to be safe when performed by EPs or trained EM residents and has comparable adverse event rates to international studies.
authors: Emergency Department, Catharina Hospital, Eindhoven, The Netherlands.
authors: Gaël Jp
authors: GJ
authors: Smits
authors: Emergency Department, Tergooi Ziekenhuis, Hilversum, The Netherlands.
authors: Maybritt I
authors: MI
authors: Kuypers
authors: Emergency Department, Maxima Medical Centre, Veldhoven, The Netherlands.
authors: Lisette Aa
authors: LA
authors: Mignot
authors: Emergency Department, St. Elisabeth Hospital, Tilburg, The Netherlands.
authors: Eef Pj
authors: EP
authors: Reijners
authors: Emergency Department, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
authors: Erick
authors: E
authors: Oskam
authors: Emergency Department, Medisch Centrum Haaglanden, The Hague, The Netherlands.
authors: Karen
authors: K
authors: Van Doorn
authors: Emergency Department, Catharina Hospital, Eindhoven, The Netherlands.
authors: Wendy Amh
authors: WA
authors: Thijssen
authors: Department of Anaesthesiology, Intensive Care and Pain Catharina Hospital, Eindhoven, The Netherlands.
authors: Erik Hm
authors: EH
authors: Korsten
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000379:methods; D002983:Clinical Competence / Q000592:standards / Q000706:statistics & numerical data; D016292:Procedural Sedation / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology / Q000627:therapeutic use*; D007649:Ketamine / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008874:Midazolam / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D009426:Netherlands; D010820:Physicians / Q000592:standards* / Q000706:statistics & numerical data; D015742:Propofol / Q000494:pharmacology / Q000627:therapeutic use; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D007649:Ketamine; D008874:Midazolam; D015742:Propofol
keywords: anaesthesia; analgesia/pain control; effectiveness