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.

Table 2: Indications for procedural sedation, stratified by urgency
  • Emergent (e.g. cardioversion for life-threatening dysrhythmia, reduction of markedly angulated fracture/dislocation with soft tissue or vascular compromise, intractable pain or suffering).
  • Urgent (e.g. care of dirty wounds and lacerations, animal and human bites, fracture reduction, shoulder reduction, hip reduction, arthrocentesis, neuroimaging for trauma).
  • Semi-urgent (e.g. care of clean wounds and lacerations, foreign body removal, sexual assault examination).

Learning Bite

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

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