Procedural Sedation in the Community Emergency Department: Initial Results of the ProSCED Registry

Sacchetti, Alfred; Senula, Gary; Strickland, J. H.; Dubin, Reva

doi:10.1197/j.aem.2006.05.023

Cited by 66 publications

(10 citation statements)

References 27 publications

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“…( 4 ) It is well established that all pharmacologic agents used for sedation can present some adverse effects. ( 16 ) Among the pharmacologic agents routinely used for sedation, ketamine and propofol have been previously reported to have the lowest incidence of adverse events. ( 16 )…”

Section: Adverse Effectsmentioning

confidence: 99%

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Ketamine use in critically ill patients: a narrative review

Midega¹,

Chaves²,

Ashihara³

et al. 2022

RBTI

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Ketamine is unique among anesthetics and analgesics. The drug is a rapid-acting general anesthetic that produces an anesthetic state characterized by profound analgesia, preserved pharyngeal-laryngeal reflexes, normal or slightly enhanced skeletal muscle tone, cardiovascular and respiratory stimulation, and occasionally a transient and minimal respiratory depression. Research has demonstrated the efficacy of its use on anesthesia, pain, palliative care, and intensive care. Recently, it has been used for postoperative and chronic pain, as an adjunct in psychotherapy, as a treatment for depression and posttraumatic stress disorder, as a procedural sedative, and as a treatment for respiratory and/or neurologic clinical conditions. Despite being a safe and widely used drug, many physicians, such as intensivists and those practicing in emergency care, are not aware of the current clinical applications of ketamine. The objective of this narrative literature review is to present the theoretical and practical aspects of clinical applications of ketamine in intensive care unit and emergency department settings.

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Section: Adverse Effectsmentioning

confidence: 99%

“…( 16 ) Among the pharmacologic agents routinely used for sedation, ketamine and propofol have been previously reported to have the lowest incidence of adverse events. ( 16 )…”

Section: Adverse Effectsmentioning

confidence: 99%

Ketamine use in critically ill patients: a narrative review

Midega¹,

Chaves²,

Ashihara³

et al. 2022

RBTI

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“…A 1995 study by Quine reported a mortality rate of approximately one in every 2000 patients sedated for gastroscopy in the United Kingdom (UK) and found that only 40% of the patients had monitoring of oxygen saturation during the procedure [ 1 ]. Since then, multiple studies have proved that procedural sedation is safe and deaths are eradicated when the current sedation guidelines are adhered to [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Comparing the Safety and Effectiveness of Ketamine Versus Benzodiazepine/Opioid Combination for Procedural Sedation in Emergency Medicine: A Comprehensive Review and Meta-Analysis

Zaki¹,

Ibrahim²,

Osman³

et al. 2023

Cureus

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Procedural sedation is essential in the ED to conduct painful procedures effectively. Ketamine and benzodiazepines/opioids are commonly used, with ketamine providing adequate analgesia and preserving airway muscle tone. However, ketamine is associated with adverse effects while benzodiazepines/opioids can lead to respiratory depression. This study compares the safety and efficacy of ketamine and midazolam/fentanyl. Two search methods were used to identify studies related to our topic, including a database search and a manual search involving screening reference lists of articles retrieved by the database search. A methodological quality appraisal was conducted on the articles suitable for inclusion using Cochrane's risk of bias tool in the Review Manager software (Review Manager (RevMan) (Computer program). Version 5.4, The Cochrane Collaboration, 2020). Moreover, pooled analysis was performed using the Review manager software.The study analyzed 1366 articles, of which seven were included for analysis. Pooled data showed that ketamine and midazolam/fentanyl had similar effects on pain scores during procedures and sedation depth measured by the University of Michigan sedation scale. However, the Modified Ramsay Sedation Score showed significantly more profound sedation in the ketamine group. The only significant adverse events were vomiting and nausea, which had a higher incidence in the ketamine group.Our data suggest that ketamine is as effective as the midazolam/fentanyl combination for procedural sedation but is associated with higher incidences of adverse events. Therefore, midazolam/fentanyl can be recommended for procedural sedation in the ED. However, it should be provided in the presence of a physician comfortable with airway management due to high incidences of oxygen desaturation.

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“…There has been an increase in the number of procedures requiring deep sedation, including minimally invasive surgeries and nonsurgical procedures commonly performed in outpatient settings such as upper gastrointestinal endoscopy, colonoscopy, and bronchoscopy [10]. Procedural sedation is also common in emergency departments for dislocated joint reduction, fracture care, and cardioversion, among others [11,12]. In those settings, etomidate and ketamine are agents of choice in addition to midazolam and propofol [11].…”

Section: Introductionmentioning

confidence: 99%

“…Procedural sedation is also common in emergency departments for dislocated joint reduction, fracture care, and cardioversion, among others [11,12]. In those settings, etomidate and ketamine are agents of choice in addition to midazolam and propofol [11]. The use of propofol for sedation in these procedures is growing, and current guidelines recommend for it to be administered by anesthesiologists [13].…”

Section: Introductionmentioning

confidence: 99%

Rapidly Metabolized Anesthetics: Novel Alternative Agents for Procedural Sedation

Colao¹,

Rodriguez-Correa²

2016

J Anesth Clin Res

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Procedural Sedation in the Community Emergency Department: Initial Results of the ProSCED Registry

Abstract: Community emergency physicians deliver safe and effective PSA over a wide variety of ages and procedures while using a broad selection of agents.

Cited by 66 publications

References 27 publications

Ketamine use in critically ill patients: a narrative review

Ketamine use in critically ill patients: a narrative review

Comparing the Safety and Effectiveness of Ketamine Versus Benzodiazepine/Opioid Combination for Procedural Sedation in Emergency Medicine: A Comprehensive Review and Meta-Analysis

Rapidly Metabolized Anesthetics: Novel Alternative Agents for Procedural Sedation

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