MANIPULATION UNDER SEDATION IN THE ACCIDENT AND EMERGENCY DEPARTMENT

The Royal College of Surgeons of England recently published guidelines for sedation by non-anaesthetists. The report emphasizes sedation for endoscopy and dental surgery, but the recommendations are equally rel evant to accident and emergency (A&E) medicine. Current sedation pract ice for orthopaedic manipulations was determined by questionnaire in 5 8 A&E and orthopaedic junior staff in one teaching and one district ge neral hospital. Of the 50 doctors who completed the questionnaire, 14 (28%) respondents made an inadequate pre-sedation assessment. Over hal f were unable to name the antagonist to benzodiazepine drugs. Eleven ( 22%) doctors administered supplemental oxygen to all their patients, 1 2 (24%) did not consider it necessary. Pulse oximetry was used for pat ient monitoring by one respondent (2%). None of the junior staff had r eceived any formal training in sedation techniques. Thirty-one (62%) h ad attended a resuscitation refresher course within the last year. The se results emphasize the need for training in sedation techniques for A&E and orthopaedic juniors and the importance of appropriate supervis ion.