Procedural Sedation and Analgesia

1. See Also
   1. Labor Sedation
   2. Local Skin Anesthesia
2. Definitions
   1. PSAA has replaced term Conscious Sedation
3. Indications
   1. Adult precedural Sedation
      1. Fracture or dislocation reduction
      2. Significant Wound Debridement
      3. Rectal foreign body
      4. Ketamine is usually preferred in children
   2. Child Procedural Sedation
      1. Ear Foreign Body
      2. Entrapment of penis in zipper
      3. Abscess Incision and Drainage
      4. Imaging studies
      5. Laceration Repair or Wound Debridement
      6. Fracture or dislocation reduction
4. Contraindications
   1. Significant or unstable cormorbid illness
5. Preparation
   1. Requires provider experienced in Sedation
      1. Knowledgeable about sedatives and monitoring
      2. Skilled in ABC Management
   2. Fasting is preferred prior to procedure
      1. Food intake is not absolute contraindication
         1. Aspiration is less likely with fasting
         2. Urgent procedures may be performed without fast
      2. Guidelines
         1. No food in last 6 hours
         2. No clear liquids in last 2 hours
   3. Monitoring during procedure
      1. Cardiac monitoring
      2. Pulse oximetry
   4. Emergency equipment
      1. Oxygen Delivery
      2. Airway Suction equipment
      3. Bag-valve mask
      4. Intubation equipment
      5. Resuscitation cart
      6. Reversal agents
         1. Naloxone
         2. Flumazenil
6. Agents
   1. Adults
      1. Etomidate (preferred agent)
      2. Propofol
      3. Fentanyl with Midazolam
   2. Children
      1. Ketamine (preferred agent)
      2. Fentanyl with Midazolam
      3. Chloral Hydrate
         1. Replaced by Ketamine
7. References
   1. Brown (2005) Am Fam Physician 71:85-90