Procedural sedation in a tertiary referral trauma centre: A retrospective audit


Submitted: 9 April 2019
Accepted: 8 August 2019
Published: 23 August 2019
Abstract Views: 756
PDF: 397
Publisher's note
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

  • James Falconer Emergency Department, Canberra Hospital and Health Service, Garran, Australian Capital Territories; Australian National University, Australian Capital Territories, Australia.
  • Drew Richardson Emergency Department, Canberra Hospital and Health Service, Garran, Australian Capital Territories; Australian National University, Australian Capital Territories, Australia.

Procedural sedation complications are common in Australasian Emergency Departments (EDs). This study aimed to compare procedural sedation complications between The Canberra Hospital ED (TCH ED) and the available Australasian literature and to determine if sedation associated complications were amenable to simple intervention. All procedural sedations performed over two and half years in TCH ED were retrospectively reviewed. Complications were defined as per the previous comparable Australasian study, as those events requiring an intervention. 1793 sedations were reviewed: 1125 (63%) for orthopaedic procedures, other 276 (a collection of painful procedures), 208 suturing and 169 direct current cardioversions. The median age was 29 years with 538 (30%) children under the age of 16 years. The complication rate in the initial six-months was 4.0% dropping to 1.3% after multiple education sessions before rebounding to 3.1% in the last six-months. The overall complication rate was 3.1% (95% CI 2.3-4.0) which is significantly lower (P<0.0001) than the comparable previous major Australian study (7.2%, 95% CI 6.2-8.2). There was significantly less use of Midazolam (10.3% vs 23.8% P<0.00001) and Morphine (1.5% vs 7.9% P<0.00001). There was one case of laryngospasm requiring intubation but subsequently discharged at baseline, otherwise no recorded major adverse events. Therefore procedural sedation at TCH ED has a complication rate less than that previously reported and this may be due to evolution of the agents used. The complications seem to be readily amenable to education around prevention, but the benefit of these education sessions appears to decay over time.


Falconer, J., & Richardson, D. (2019). Procedural sedation in a tertiary referral trauma centre: A retrospective audit. Emergency Care Journal, 15(2). https://doi.org/10.4081/ecj.2019.8214

Downloads

Download data is not yet available.

Citations