https://doi.org/10.4081/ecj.2024.12339
Procedural sedation and analgesia by Italian emergency physicians: a retrospective observational pilot study
Submitted: 31 January 2024
Accepted: 28 May 2024
Published: 27 June 2024
Accepted: 28 May 2024
Abstract Views: 154
PDF: 94
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Procedural Sedation and Analgesia (PSA) is a routine practice in Emergency Departments (EDs) but few data exist in the setting of Italian ED. Thus, this study aimed to describe for the first time an Italian experience of PSA in the ED, defining usual indications, types of drug used, efficacy, and safety. We retrospectively collected consecutive adult patients undergoing PSA in the ED of the Santa Croce e Carle Hospital in Cuneo, Italy, over 6 years; we enrolled all patients who received at least one of the four drugs used for PSA (midazolam, propofol, ketamine, and fentanyl). 384 patients (62.2% male; median age 61 [42;76] years) were included in the study. Two hundred and six PSA (53.7%) were done for orthopedic maneuvers, 103 (26%) for electrical cardioversions (ECV), and 75 (19.5%) for other unpleasant medical procedures. A single drug was used in 132 cases (34.3%), while in 252 (65.7%) an association of at least two drugs was used; 239 patients (62.2%) were ASA class I, 144 (37.5%) were ASA class II and one patient was ASA class III. Three patients (0.8%) experienced PSA failure. Minor adverse events occurred during 16 procedures (4%), while no major adverse events, rescue intubation, or need for escalation of care were registered. PSA is currently used in Italian EDs and it is safe when performed by EPs for patients in ASA class I and II. An Italian prospective PSA register is to be created.
Todd KH, Ducharme J, Choiniere M, et al. Pain in the emergency department: results of the pain and emergency medicine initiative (PEMI) multicenter study. PEMI Study Group. J Pain 2007;8:460-6.
DOI: https://doi.org/10.1016/j.jpain.2006.12.005
Berben SA, Schoonhoven L, Meijs TH, et al. Prevalence and relief of pain in trauma patients in emergency medicalservices. Clin J Pain 2011;27:587-92.
DOI: https://doi.org/10.1097/AJP.0b013e3182169036
O'Connor RE, Sama A, Burton JH, et al. Procedural sedation and analgesia in the emergency department: recommendations for physician credentialing, privileging, and practice. American College of Emergency Physicians. Ann Emerg Med 2011;58:365-70.
DOI: https://doi.org/10.1016/j.annemergmed.2011.06.020
Godwin SA, Burton JH, Gerardo CJ, et al. Clinical policy: procedural sedation and analgesia in the emergency department. American College of Emergency Physicians. Ann Emerg Med 2014;63:247-58.e18.
DOI: https://doi.org/10.1016/j.annemergmed.2013.10.015
Elizabeth L Bahn, Kurtis R Holt. Procedural sedation and analgesia: a review and new concepts. Emerg Med Clin North Am 2005;23:503-17.
DOI: https://doi.org/10.1016/j.emc.2004.12.013
Kuypers MI, Mencl F, Verhagen MF, et al. Safety and efficacy of procedural sedation with propofol in a country with a young emergency medicine training program. Eur J Emerg Med 2011;18:162-7.
DOI: https://doi.org/10.1097/MEJ.0b013e32834230fb
American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002;96:1004-17.8.
DOI: https://doi.org/10.1097/00000542-200204000-00031
Quine MA, Bell GD, McCloy RF, et al. Prospective audit of upper gastrointestinal endoscopy in two regions of England: safety, staffing, and sedation methods. Gut 1995;36:462-7.
DOI: https://doi.org/10.1136/gut.36.3.462
Royal College of Anaesthetists and The College of Emergency Medicine. Safe Sedation of Adults in the Emergency Department. Report and Recommendations by The Royal College of Anaesthetists and The College of Emergency Medicine Working Party on Sedation, Anaesthesia and Airway Management in the Emergency Department; 2012.
Pharmacological Agents for Procedural Sedation and Analgesia in the Emergency Department, T.R.C.o.E. Medicine, Editor. 2017.
ASA Physical Status Classification System. 2014, American Socety of Anesthesiologists. Available from: www.asahq.org
Mason KP, Roback MG, Chrisp D, Sturzenbaum N, Freeman L, Gozal D, Vellani F, Cavanaugh D, Green SM. Results from the Adverse Event Sedation Reporting Tool: A Global Anthology of 7952 Records Derived from >160,000 Procedural Sedation Encounters. J Clin Med. 2019 Dec 1;8(12):2087. doi: 10.3390/jcm8122087. PMID: 31805686; PMCID: PMC6947169.
DOI: https://doi.org/10.3390/jcm8122087
Mason KP, Green SM, Piacevoli Q, International Sedation Task Force. Adverse event reporting tool to standardize the reporting and tracking of adverse events during procedural sedation: a consensus document from the World SIVA International Sedation Task Force. Br J Anaesth 2012;108:13-20.
DOI: https://doi.org/10.1093/bja/aer407
Farmaco, A.I.d. Propofol foglio illustrativo. 2019; Available from: https://farmaci.agenziafarmaco.gov.it
Savoia G, Coluzzi F, Di Maria C, et al. Italian Intersociety Recommendations on pain management in the emergency setting (SIAARTI, SIMEU, SIS 118, AISD, SIARED, SICUT, IRC). Minerva Anestesiol 2015;81:205-25.
Fodale V, Pratico C, Santamaria LB. Coadministration of propofol and midazolam decreases bispectral index value as a result of synergic muscle relaxant action on the motor system. Anesthesiology 2004;101:799; author reply 800-1.
DOI: https://doi.org/10.1097/00000542-200409000-00033
Olkkola KT, Ahonen J. Midazolam and other benzodiazepines. Handb Exp Pharmacol 2008;182:335-60.
DOI: https://doi.org/10.1007/978-3-540-74806-9_16
Bawden J, Villa-Roel C, Singh M, et al. Procedural sedation and analgesia in a Canadian ED: a time-in-motion study. Am J Emerg Med 2011;29:1083-8.
DOI: https://doi.org/10.1016/j.ajem.2010.06.036
McGrane O, Hopkins G, Nielson A, Kang C. Procedural sedation with propofol: a retrospective review of the experiences of an emergency medicine residency program 2005 to 2010. Am J Emerg Med 2012;30:706-11.
DOI: https://doi.org/10.1016/j.ajem.2011.04.002
Atkinson P, French J, Nice CA. Procedural sedation and analgesia for adults in the emergency department. BMJ 2014;348:g2965.
DOI: https://doi.org/10.1136/bmj.g2965
Hohl CM, Sadatsafavi M, Nosyk B, Anis AH. Safety and clinical effectiveness of midazolam versus propofol for procedural sedation in the emergency department: a systematic review. Acad Emerg Med 2008;15:1-8.
DOI: https://doi.org/10.1111/j.1553-2712.2007.00022.x
Holger JS, Satterlee PA, Haugen S. Nursing use between 2 methods of procedural sedation: midazolam versus propofol. Am J Emerg Med 2005;23:248-52.
DOI: https://doi.org/10.1016/j.ajem.2005.01.001
Chudnofsky CR, Weber JE, Stoyanoff PJ, et al. A combination of midazolam and ketamine for procedural sedation and analgesia in adult emergency department patients. Acad Emerg Med 2000;7:228-35.
DOI: https://doi.org/10.1111/j.1553-2712.2000.tb01064.x
Messenger DW, Murray HE, Dungey PE, et al. Subdissociative-dose ketamine versus fentanyl for analgesia during propofol procedural sedation: a randomized clinical trial. Acad Emerg Med 2008;15:877-86.
DOI: https://doi.org/10.1111/j.1553-2712.2008.00219.x
Sheikh S, Hendry P. The expanding role of ketamine in the emergency department. Drugs 2018;78:727-35.
DOI: https://doi.org/10.1007/s40265-018-0904-8
Pourmand A, Mazer-Amirshahi M, Royall C, et al. Low dose ketamine use in the emergency department, a new direction in pain management. Am J Emerg Med 2017;35:918-21.
DOI: https://doi.org/10.1016/j.ajem.2017.03.005
Jalili M, Bahreini M, Doosti-Irani A, et al. Ketamine-propofol combination (ketofol) vs propofol for procedural sedation and analgesia: systematic review and meta-analysis. Am J Emerg Med 2016;34:558-69.
DOI: https://doi.org/10.1016/j.ajem.2015.12.074
Ghojazadeh M, Sanaie S, Paknezhad SP, et al. Using ketamine and propofol for procedural sedation of adults in the emergency department: a systematic review and meta-analysis. Adv Pharm Bull 2019;9:5-11.
DOI: https://doi.org/10.15171/apb.2019.002
Zaki HA, Shallik N, Shaban E, et al. An analytical comparison between ketamine alone and a combination of ketamine and propofol (ketofol) for procedural sedation and analgesia from an emergency perspective: a systematic review and meta-analysis. Cureus 2022;14:e27318.
DOI: https://doi.org/10.7759/cureus.27318
Bellolio MF, Gilani WI, Barrionuevo P, et al. Incidence of adverse events in adults undergoing procedural sedation in the emergency department: a systematic review and meta-analysis. Acad Emerg Med 2016;23:119-34.
DOI: https://doi.org/10.1111/acem.12875
Yusuff H, Prakash A, Webb S. Safe sedation for the non-anaesthetist. Clin Med (Lond) 2016;16:161-3.
DOI: https://doi.org/10.7861/clinmedicine.16-2-161
Homfray G, Palmer A, Grimsmo-Powney H, et al. Procedural sedation of elderly patients by emergency physicians: a safety analysis of 740 patients. Br J Anaesth 2018;121:1236-41.
DOI: https://doi.org/10.1016/j.bja.2018.07.038
How to Cite
Lorenzati, B., Abram, S., Giamello, J. D., Bruno, A., Gambardella, L., Lison, D., D’Agnano, S., Martini, G., Sciolla, A., & Lauria, G. (2024). Procedural sedation and analgesia by Italian emergency physicians: a retrospective observational pilot study. Emergency Care Journal. https://doi.org/10.4081/ecj.2024.12339
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