Key Learning Points

Don’t default to procedural sedation without considering alternative options or adjuncts to your strategy. The latter may enable you to use lighter levels of sedation.
In your preparation for procedural sedation always ask yourself whether you would be able to ventilate and oxygenate the patient if necessary.
The risks of aspiration, whilst small, should be considered in all patients. If a procedure is not required emergently, it may be appropriate to delay the procedure (to prolong fasting) or defer it completely in patients where aspiration risk is deemed unacceptably high.
Use smaller initial doses of sedative in the elderly, debilitated and acutely ill patients.
A minimum of three staff members is required for safe sedation. All sedation should take place in a resuscitation area, with full monitoring (ECG, SaO2, etCO2 and BP).
Monitoring for 30 minutes from the last dose of sedative agent is appropriate
IV ketamine is a safe and effective sedative agent for use in children.
Laryngospasm is a rare but real side effect of ketamine use, and its management should be incorporated within a regular training programme.