Authors: Tom Bannister / Codes: PC1, PC4, SLO4, SLO5, SLO6, TC2, TP7 / Published: 17/06/2024

Scope / Reason for development

Procedural sedation in adults and children (excluding neonates) in the Emergency Department (ED). This guidance does not provide advice regarding anaesthesia or use of Entonox® or methoxyflurane or variable concentration nitrous oxide.

Procedural sedation (PS) may avoid the need for admission for general anaesthesia both in adults and children, but this must not be to the detriment of patient safety or quality of care. This document provides guidance on governance structures as well as staffing, equipment and pharmacological agents and doses.

Summary of Recommendations

1. Every emergency department should have a sedation lead responsible for ensuring the appropriate governance structures are in place in relation to procedural sedation. 

2. Emergency departments undertaking paediatric procedural sedation should have a nominated paediatric sedation lead and specific paediatric guidelines. 

3. The use of a sedation proforma or similar electronic equivalent is strongly recommended. 

4. Processes should be in place for adverse incident reporting arising from procedural sedation as well as rapid investigation of significant events. 

5. Emergency departments should have clear policies with regards competencies for the provision of procedural sedation in both adults and children as well as, up to date lists of those clinicians fulfilling the competencies. 

6. Simulation training sessions should be used to promote safe and effective procedural sedation in line with local policies. 

7. Procedural sedation should take place in a designated area of the emergency department with the requisite staffing levels and equipment e.g., resuscitation room. 

8. Procedural sedation should not take place without careful consideration of the analgesic requirement for the procedure, taking into account any analgesics already administered. 

9. The clinician who will be responsible for providing the procedural sedation should undertake a pre-procedure Safety Brief with the other members of the team. 

10. The use of oxygen during procedural sedation is encouraged especially for at risk patient groups (e.g., ischaemic heart disease) and those undergoing deep sedation procedures (increased risk of short periods of apnoea). 

11. Monitoring during procedural sedation should include: 3 lead ECG, oxygen saturations, continuous capnography, non-invasive blood pressure.  12. The use of a patient advice leaflet is encouraged.

Ensure that you read the full Procedural Sedation in the Emergency Department Guideline

Key Information

Requirements for Adult Procedural Sedation

Adult: Pharmacological Agents for Procedural Sedation

Paediatric: Pharmacological Agents for Procedural Sedation

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