• Emerg Med Australas · Aug 2011

    Multicenter Study

    Procedural sedation practices in Australian Emergency Departments.

    • Anthony Bell, David McD Taylor, Anna Holdgate, Catherine MacBean, Truc Huynh, Ogilvie Thom, Michael Augello, Robert Millar, Robert Day, Aled Williams, Peter Ritchie, and John Pasco.
    • Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia.
    • Emerg Med Australas. 2011 Aug 1; 23 (4): 458-65.

    ObjectiveThe aim of the present study was to describe procedural sedation practices undertaken in a spectrum of Australian EDs.MethodsEleven Australian EDs enrolled consecutive adult and paediatric patients between January 2006 and December 2008. Patients were included if a sedative drug was administered for an ED procedure. Data collection was prospective and used a specifically designed data collection document.Results2623 patients were enrolled. 1581 were male (60.3%, 95% CI 58.4-62.2) and the mean patient age was 39.2 (SD 25.2) years. Reductions of fracture/dislocated shoulders (694 cases, 26.7%), wrist/forearm fractures (403, 15.5%) and tibia/fibula fractures (341, 13.1%) were the most common procedures. Procedures were supervised by consultants and registrars in 1424 (54.3%) and 1025 (39.1%) cases, respectively. Of 2413 patients with complete fasting status data, 1252 (51.9%, 95% CI 49.9-53.9) patients had consumed food or fluid in the previous 6 h. 1399 (53.3%, 95% CI 51.4-55.3) patients received pre-procedural medication. Pre-procedural morphine (894, 34.1%) exceeded fentanyl use (323, 12.3%), both as a sole agent and in combination with another agent. The principal sedatives used alone were propofol (857, 38.5%), midazolam (224, 10%) and ketamine (165, 7.4%). Ketamine and nitrous oxide were most commonly used in children with propofol, midazolam and opiates largely restricted to adults (P < 0.001). The intra-procedural use of adjunct fentanyl exceeded that of morphine (ratio 4:1).ConclusionsProcedural sedation practice across Australian EDs is varies considerably. Procedural sedation 'best practice' guidelines, based upon the findings of the present study and the available evidence, are recommended.© 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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