Indications for procedural sedation

Sedation can be very useful for the successful completion of a variety of short painful procedures. However, it is worth considering:

• Can the procedure be performed just as well using local or regional anaesthesia, Entonox or Penthrox?
• Have you put yourself in the patient’s position and provided an empathetic approach, a clear explanation of the procedure, a distracting conversation or provided perhaps an alternative distractive medium, such as music or a tablet?
• Is a general anaesthetic more appropriate – is the procedure more complicated than you think?
• Does the current workload in your department allow safe procedural sedation to take place? Consider in particular the time of day, senior cover available should there be a problem, space in designated sedation areas such as the resuscitation room – will performing procedural sedation at this time compromise the safety or quality of care for other patients?

Table 2 lists some typical indications for procedural sedation and stratifies them loosely (you should take each case on its individual merits) in terms of urgency.

Learning Bite

Don’t default to providing procedural sedation without considering alternative options or adjuncts.