Procedural Sedation & Analgesia

EMplify by EB Medicine

In this episode, Sam Ashoo, MD interviews Prayag Mehta, MD and Joshua Kern, MD – two of the authors of the June, 2022 EMP article on Procedural Sedation and Analgesia in the Emergency Department. Listen to the discussion to hear more about the emergency medicine approach to sedation in adults and pediatrics !

Procedural Sedation and Analgesia in the Emergency Department

EMplify – June 2022

Episode Outline:

1.Procedural sedation and analgesia (PSA): terminology

2.Levels of sedation

• Minimal
• Moderate
• Deep
• General anesthesia

3.Prehospital care

4.ED care: patient assessment

• ASA class system
• Complications
• Equipment needed (Table 1)
• Larson maneuver (Figure 2)

5.Procedural technique

• Current ACEP and AAP recommendations
• Data for 1- or 2-physician sedation

6.Preprocedural fasting

• Do we even need to consider this in PSA?

7.Capnography

8.Oxygen supplementation

9.Preprocedural opioids

10.Preprocedural sedatives

11.Anticholinergics

12.Antiemetics

13.Treatment (Table 2)

• Fentanyl
• Remifentanil
• Midazolam
• Nitrous oxide
• Propofol
• Ketamine
• Ketofol
• Etomidate

14.Reversal agents

• Naloxone
• Flumazenil

15.Special populations

• Pediatrics
• Pregnancy
• Geriatrics

16.Cutting edge

• Dexmedetomidine