Procedural sedation and analgesia practices by emergency physicians in the Netherlands: a nationwide survey

Kuypers, Maybritt I.; Smits, G. J. P.; Valkenet, Suzanne C.; Thijssen, Wendy A M H; Plötz, Frans B.

doi:10.1186/s12245-017-0159-2

Cited by 6 publications

(12 citation statements)

References 15 publications

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“…Sedation for wound stitching or fracture reposition was rarely reported in our survey, which may reflect the common use of local anaesthesia in these procedures, as well as the low number of paediatric surgeons and lack of emergency medicine physicians among the respondents. However, the finding differed from a recent survey performed in emergency departments in the Netherlands, in which wound management, fractures and joint dislocations were the most common indications for paediatric procedural sedation 20 …”

Section: Discussioncontrasting

confidence: 98%

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National survey revealed variable practices in paediatric procedural sedation and patient monitoring

Tervonen

Kallio

Peltoniemi

2021

Acta Anaesthesiol Scand

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Paediatric procedures requiring sedation are increasingly being performed off site, but there are no national guidelines for paediatric procedural sedation in Finland or studies on it. Therefore, the aim of this survey was to assess national practices for paediatric procedural sedation outside operation rooms and intensive care units in terms of indications, sedative medication, treatment facilities, patient safety and training of the personnel. An online survey including single‐ and multiple‐choice questions and open‐ended questions was sent to Finnish paediatricians, paediatric surgeons and paediatric anaesthesiologists via the electronic mailing lists of national societies in December 2019. A total of 71 responses were received. Lumbar puncture (41%), intra‐articular injections (38%) and MRI (17%) were the most common procedures that required routine sedation. Benzodiazepines were the most frequently used sedatives during both painful procedures (80%) and imaging (61%). Pulse oximetry monitoring was reported by 75% of the respondents, but other physiological parameters were rarely monitored (ECG 28%; blood pressure 39%; respiratory rate 34%). The level of sedation was not objectively assessed. Adrenaline (72%) and equipment for managing adverse respiratory outcomes (supplemental oxygen 98%; ventilation equipment 92%) were available in most facilities in which sedation was performed. Only one‐third of the respondents had undergone training for paediatric procedural sedation, and only 39% of the hospital units compiled statistical data on sedation‐related adverse events. The paediatric procedural sedation practices vary across hospitals. National guidelines for patient monitoring and training of personnel could improve treatment quality and patient safety.

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Section: Discussioncontrasting

confidence: 98%

“…Midazolam was the most popular sedative in our survey, and as per published reports, it appears to be in widespread use for paediatric sedation around Europe 15,20 . Propofol and thiopental were more commonly prescribed by anaesthesiologists, reflecting the current recommendations of the European Society of Anaesthesiology 8 .…”

Section: Discussionsupporting

confidence: 62%

National survey revealed variable practices in paediatric procedural sedation and patient monitoring

Tervonen

Kallio

Peltoniemi

2021

Acta Anaesthesiol Scand

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“…We included sedations for the dislocation of artificial hips, which is among the most frequent indications for PSA. 5 , 6 , 12 Hip dislocations are readily identifiable in the electronic patient system. In addition, hip dislocations usually require sedation as part of their treatment.…”

Section: Methodsmentioning

confidence: 99%

“…PSA is an integral part of emergency medicine (EM) practice. 5 , 6 Studies demonstrate the safety of PSA when performed by trained emergency physicians (EPs). 1 , 3 , 4 , 7 , 8 …”

Section: Introductionmentioning

confidence: 99%

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Documentation of Procedural Sedation by Emergency Physicians

Veen¹,

Zwaal²,

Linden³

2021

DHPS

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Introduction Patients presenting to the emergency department (ED) frequently require procedural sedation and analgesia (PSA) to facilitate procedures, such as joint reduction. Proper documentation of screening demonstrates awareness of the necessity of presedation assessment. It is unknown if introducing emergency physicians (EPs) at the ED improves presedation assessment and documentation. In this study the differences in documentation of ED sedation and success rates for reduction of hip dislocations in the presence versus absence of EPs are described. Methods In this retrospective descriptive study, we analyzed data of patients presenting with a dislocated hip post total hip arthroplasty (THA) shortly after the introduction of EPs. The primary outcome measure was the presence of documentation of presedation assessment. Secondary outcomes were documentation of medication, vital signs, and success rate of hip reductions. Results In the two-year study period, 133 sedations for hip reductions were performed. Sixty-eight sedations were completed by an EP. The documentation of fasting status, airway screening, analgesia use, and vital signs was documented significantly more often when an EP was present (respectively 64.9%, 80.3%, 37.4%, and 72.7%, all P < 0.001). There was no difference in success rate of hip reductions between the groups. Conclusion PSA in the ED is associated with superior documentation of presedation assessment, medication, and vital signs when EPs are involved.

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National Survey to Describe the Current Patterns of Procedural Sedation Practices Among Pediatric Emergency Medicine Practitioners in the United States

et al. 2020

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Objective: Pediatric procedural sedation (PPS) is used to maintain children's safety, comfort, and cooperation during emergency department procedures. Our objective was to gather data describing PPS practice across the United States to highlight the variations in practice and adherence to National Guidelines. Methods:We performed a nationwide survey of PPS practitioners using a secure web-based software program. A link to the survey was sent to all subscribers of a pediatric emergency medicine listserv. We collected participant demographics, their PPS approach for personnel, monitoring, equipment, postsedation observation, and side effects, as well as providers' medication preferences for 3 common PPS scenarios. Results:We received 211 completed surveys from 34 States. There were 20.6% respondents that were based in New York, 83.4% were pediatric emergency medicine attendings, and 91.7% were based in the United States teaching hospitals. Our participants learned PPS by various methods, most commonly: observation of at least 10 PPS (29.9%); self-study (24.8%); and classroom lectures (24.5%). Seventy-seven percent of our participants reported no body mass index cutoff to do PPS. There were 31.5% of our participants that observe children after PPS up to 1 hour, 30.1% up to 2 hours. There were 67.7% of the PPS providers that were a separate person from the practitioner doing the procedure, and 98.2% required a separate trained nurse to be present for monitoring. There were 92.6% of PPS providers that measure end-tidal carbon dioxide (ETCO 2 ) during the sedation. Most PPS providers reported having no reversal agents (71.4%) and no defibrillator (65.9%) at bedside. For the abscess drainage scenario, 22% of participants preferred local anesthetic alone, and 22.5% preferred utilizing local anesthetic in combination with intravenous ketamine. For a forearm fracture reduction scenario, 62.8% of participants would choose intravenous ketamine alone. For the laceration repair scenario, the most favored drug combination was local anesthesia + intranasal midazolam by 39.8% of participants.Conclusions: Our study demonstrates a wide variability in several aspects of PPS and low adherence to national PPS guidelines.

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Procedural sedation and analgesia practices by emergency physicians in the Netherlands: a nationwide survey

Cited by 6 publications

References 15 publications

National survey revealed variable practices in paediatric procedural sedation and patient monitoring

National survey revealed variable practices in paediatric procedural sedation and patient monitoring

Documentation of Procedural Sedation by Emergency Physicians

National Survey to Describe the Current Patterns of Procedural Sedation Practices Among Pediatric Emergency Medicine Practitioners in the United States

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