Safe and Efficacious Use of Procedural Sedation and Analgesia by Nonanesthesiologists in a Pediatric Emergency Department

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Abstract
Background Children often require relief of pain and anxiety when undergoing diagnostic or therapeutic procedures in the emergency department (ED). Procedural sedation and analgesia (PSA) has become standard practice in the outpatient setting for such procedures. Few studies have looked at the overall success and incidence of complications of PSA as performed by nonanesthesiologists. Objectives To prospectively describe PSA as performed in a pediatric ED and to report the success of sedation and incidence of complications. Design Prospective descriptive study. Setting and Population Subjects aged 0 to 21 years presenting to the ED of an urban, tertiary care, children's hospital between May 1, 1997, and April 30, 1999, requiring PSA for a diagnostic or therapeutic procedure. Methods A PSA form was designed and used by ED personnel to record pertinent clinical and demographic characteristics of patients, information related to the procedure, vital signs, and occurrence of complications.Success of sedationwas defined a priori as successful completion of the procedure in a minimally responsive subject.Complicationswere defined as apnea, hypoxia (sustained pulse oximetry, P<.001), while patients sedated using IV ketamine, midazolam, and atropine (P= .006) or IV midazolam alone (P= .005) were less likely. No difference in success of sedation or incidence of complications at follow-up was found between the types of PSA provided. Conclusions Complications related to PSA occurred in 17.9% of patients, but most commonly consisted of hypoxia that was easily treated. Sedation was successful in 98.6% of patients. Procedural sedation and analgesia can be safely and effectively provided by nonanesthesiologists in a pediatric ED.