Context

The aim of procedural sedation is to relieve a patient’s anxiety towards, and facilitate their cooperation with, a potentially painful procedure, such as a manipulation of a fracture or dislocation.

The general principles of managing painful procedures in ED are [1]:

• Patient explanation, in order to alleviate anxiety
• Identify potentially painful components of the procedure in advance so that local anaesthetic or systemic analgesic drugs can be administered
• Prevent pain whenever possible. Most sedative agents have no significant analgesic effect, therefore analgesia is recommended beforehand
• Drug sedation should not be used for operator convenience, but as a supplement to behavioural management
• When conscious sedation is employed, the agents and doses chosen must be adjusted to the individual patient
• Formal competency-based training is recommended for all practitioners because these techniques have the potential to cause life-threatening complications particularly in elderly patients or those with co-morbidities.