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Procedural sedation in the emergency department
The Journal of the American Academy of Orthopaedic Surgeons
|February 27, 2015
Summary
Emergency department procedural sedation enhances orthopaedic care safety and effectiveness. Options range from traditional agents to newer drugs like etomidate and propofol, with combinations offering synergistic benefits.
Area of Science:
- Emergency medicine
- Orthopaedic surgery
- Pharmacology
Background:
- Procedural sedation in the emergency department (ED) is crucial for delivering orthopaedic care.
- Traditional sedation agents remain relevant, but newer options offer improved efficacy and safety.
Purpose of the Study:
- To review current procedural sedation options for orthopaedic care in the ED.
- To highlight the effectiveness of various agents, combinations, and alternative methods.
Main Methods:
- Review of traditional and contemporary procedural sedation agents used in the ED.
- Discussion of combination sedation regimens and alternative techniques like local blocks and intranasal delivery.
- Emphasis on clinical scenario appropriateness for orthopaedic surgeons.
Main Results:
- Traditional agents (nitrous oxide, midazolam, fentanyl, ketamine) maintain a role.
- Etomidate and propofol are effective recent additions.
- Combination regimens (ketamine-midazolam, ketamine-propofol) may offer synergistic advantages.
- Local blocks in adults and intranasal delivery in children are viable alternatives.
Conclusions:
- A range of procedural sedation options are available for ED orthopaedic care.
- Understanding the appropriateness of different regimens is essential for optimal patient outcomes.
- Orthopaedic surgeons must be aware of these evolving sedation strategies.
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