When is it Appropriate?

Indications for procedural sedation

Typically this will be for reduction of a fracture or dislocation [3,4]. Other indications include incision and drainage of an abscess, laceration repair, lumbar puncture, change of burns dressings or cardioversion

Contraindications for procedural sedation

Procedural sedation is contraindicated in the ED when:

  • Appropriately trained personnel are not available to perform the sedation
  • Patients have an American Society of Anesthesiologists (ASA) classification of unstable class II or class IV and above (unless requiring immediate intervention, e.g. ventricular tachycardia).
  • Appropriate monitoring and resuscitation equipment are not available
  • A general anaesthetic would be more appropriate
  • The patient has an allergy or hypersensitivity to the relevant medications
  • There is a high risk of aspiration, e.g. acute alcohol intoxication
  • The patient declines procedural sedation