Procedural sedation and analgesia in the emergency department. Canadian consensus guidelines

Procedural sedation and analgesia are core skills in emergency medicine. Va rious specialty societies have developed guidelines for procedural sedation , each reflecting the perspective of the specialty group, Emergency practit ioners are most likely to embrace guidelines developed by people who unders tand emergency department (ED) skills, procedures, conditions, and case mix , Recognizing this, the Canadian Association of Emergency Physicians (CAEP) determined the need to establish guidelines for procedural sedation in the ED. In March, 1996, a national emergency medicine (EM) working committee, representing adult and pediatric emergency physicians, was established, Thi s committee teleconferenced with representatives of the Canadian Anesthetic Society (CAS) to identify problems, perspectives, and controversial issues , and to define a process for guideline development. The EM committee subse quently reviewed existing literature, determined levels of evidence, and de veloped the document, which evolved based on feedback from the CAS and CAEP Standards Committees, The final version was approved by the CAEP Standards Committee and the CAEP Board of Directors, then submitted for peer review. These guidelines discuss the goals, definitions, and principles of ED seda tion, and make recommendations for pre-sedation preparation, patient fastin g, physician skills, equipment and monitoring requirements, and post-sedati on care. The guidelines are aimed at non-anesthesiologists practicing part- time or full-time emergency medicine. They are applicable to ED patients re ceiving parenteral analgesia or sedation for painful or anxiety-provoking p rocedures, They are intended to increase the safety of procedural sedation in the ED. (C) 1999 Elsevier Science Inc.