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 are confident you can ventilate the patient if necessary
  • Before proceeding with sedation of an unstarved patient, a senior emergency physician with level 2 sedation training should be present.
  • If using benzodiazepine/opioid combinations give the opioid first to allow time for it to become maximally effective before any sedative is added
  • Use smaller initial doses of sedative in the elderly, debilitated and acutely ill patients.
  • A sedationist, operator and trained nurse are required for moderate and deep sedation target levels.
  • Capnography is currently recommended for both moderate and deep target sedation levels
  • Monitoring for 30 minutes from the last dose of sedative agent is appropriate
  • The RCEM supports the use of 1 mg/kg IV ketamine for procedural sedation in children
  • Laryngospasm is a rare but real side effect of ketamine use, and its management should be incorporated within a regular training programme
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