Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

Procedural Sedation in Emergency Department: A Narrative Review

Iacopo Cappellini
* ORCID logo ,
Gaia Bavestrello Piccini
ORCID logo ,
Lorenzo Campagnola
,
Cristina Bochicchio
,
Rebecca Carente
,
Franco Lai
,
Simone Magazzini
,
Guglielmo Consales
Version 1 : Received: 21 March 2024 / Approved: 22 March 2024 / Online: 24 March 2024 (14:29:56 CET)

A peer-reviewed article of this Preprint also exists.

Cappellini, I.; Bavestrello Piccini, G.; Campagnola, L.; Bochicchio, C.; Carente, R.; Lai, F.; Magazzini, S.; Consales, G. Procedural Sedation in Emergency Department: A Narrative Review. Emerg. Care Med. 2024, 1, 103-136. Cappellini, I.; Bavestrello Piccini, G.; Campagnola, L.; Bochicchio, C.; Carente, R.; Lai, F.; Magazzini, S.; Consales, G. Procedural Sedation in Emergency Department: A Narrative Review. Emerg. Care Med. 2024, 1, 103-136.

Abstract

Procedural Sedation and Analgesia (PSA) in the Emergency Department (ED) presents a crucial aspect of emergency medicine, enabling the execution of painful or distressing procedures with minimal patient discomfort. This narrative review delineates the pharmacological framework, methodologies, and clinical considerations integral to optimizing PSA, with a particular focus on pediatric and geriatric populations. Through a comprehensive review and analysis of current practices, this work evaluates the pharmacokinetics and pharmacodynamics of widely utilized sedatives and analgesics, including propofol, ketamine, dexmedetomidine, fentanyl, midazolam, etomidate, nitrous oxide, and remimazolam. Special attention is dedicated to the selection criteria based on patient-specific risk factors, procedural requirements, and the management of potential adverse effects. The manuscript also explores innovative sedation techniques and the integration of new pharmacological agents, emphasizing evidence-based approaches to enhance patient safety and outcome. Results underscore the significance of tailored sedation strategies, especially for vulnerable groups such as pediatric and geriatric patients, highlighting the need for meticulous pre-procedural assessment and monitoring to mitigate risks. Conclusions drawn advocate for a nuanced application of PSA, guided by current evidence and clinical guidelines, to improve the quality of care in emergency settings. This research reinforces the imperative for ongoing education, skill development, and adaptation of new evidence into clinical practice to advance procedural sedation and analgesia in the ED.

Keywords

procedural sedation; emergency medicine; pharmacological management

Subject

Medicine and Pharmacology, Emergency Medicine

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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