Procedural Sedation in Emergency Department: A Narrative Review

first_pagesettingsOrder Article Reprints Open AccessReview Procedural Sedation in Emergency Department: A Narrative Review by Iacopo Cappellini 1,*ORCID,Gaia Bavestrello Piccini 2ORCID,Lorenzo Campagnola 1,Cristina Bochicchio 3,Rebecca Carente 3,Franco Lai 4,Simone Magazzini 4 andGuglielmo Consales 1 1 Department of Critical Care, Section of Anesthesiology and Critical Care, Azienda USL Toscana Centro, Ospedale Santo Stefano, 59100 Prato, Italy 2 Emergency Medicine, Université Libre de Bruxelles, 1050 Bruxelles, Belgium 3 Faculty of Medicine and Surgery, University of Pavia, 27100 Pavia, Italy 4 Emergency Unit, Department of Critical Care and Emergency Medicine, Azienda USL Toscana Centro, Ospedale Santo Stefano, 59100 Prato, Italy * Author to whom correspondence should be addressed. Emerg. Care Med. 2024, 1(2), 103-136; https://doi.org/10.3390/ecm1020014 Submission received: 15 March 2024 / Revised: 14 April 2024 / Accepted: 17 April 2024 / Published: 26 April 2024 Downloadkeyboard_arrow_down Versions Notes Abstract Procedural sedation and analgesia (PSA) in the emergency department (ED) presents a crucial aspect of emergency medicine, enabling the execution of painful or distressing procedures with minimal patient discomfort. This narrative review delineates the pharmacological framework, methodologies, and clinical considerations integral to optimizing PSA, with a particular focus on pediatric and geriatric populations. Through a comprehensive review and analysis of current practices, this work evaluates the pharmacokinetics and pharmacodynamics of widely utilized sedatives and analgesics, including propofol, ketamine, dexmedetomidine, fentanyl, midazolam, etomidate, nitrous oxide, and remimazolam. Special attention is dedicated to the selection criteria based on patient-specific risk factors, procedural requirements, and the management of potential adverse effects. The manuscript also explores innovative sedation techniques and the integration of new pharmacological agents, emphasizing evidence-based approaches to enhance patient safety and outcome. The results underscore the significance of tailored sedation strategies, especially for vulnerable groups such as pediatric and geriatric patients, highlighting the need for meticulous pre-procedural assessment and monitoring to mitigate risks. The conclusions drawn advocate for a nuanced application of PSA, guided by current evidence and clinical guidelines, to improve the quality of care in emergency settings. This research reinforces the imperative for ongoing education, skill development, and the adaptation of new evidence into clinical practice to advance procedural sedation and analgesia in the ED.