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Table of contents
- Account Options
- Procedural sedation in emergency medicine
- A home for paediatricians. A voice for children and youth.
Risks of anesthesia or sedation outside the operating room: the role of the anesthesia care provider.
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Adams D, Dervay KR. Pharmacology of procedural sedation. Synthesized Recommendation Grading System for DynaMed DynaMed systematically monitors clinical evidence to continuously provide a synthesis of the most valid relevant evidence to support clinical decision-making see 7-Step Evidence-Based Methodology OpenInNew.
Guideline recommendations summarized in the body of a DynaMed topic are provided with the recommendation grading system used in the original guideline s , and allow DynaMed users to quickly see where guidelines agree and where guidelines differ from each other and from the current evidence. Strong recommendations are used when, based on the available evidence, clinicians without conflicts of interest consistently have a high degree of confidence that the desirable consequences health benefits, decreased costs and burdens outweigh the undesirable consequences harms, costs, burdens.
Weak recommendations are used when, based on the available evidence, clinicians believe that desirable and undesirable consequences are finely balanced, or appreciable uncertainty exists about the magnitude of expected consequences benefits and harms. Weak recommendations are used when clinicians disagree in judgments of relative benefit and harm, or have limited confidence in their judgments. Weak recommendations are also used when the range of patient values and preferences suggests that informed patients are likely to make different choices.
Recommendations are phrased to match the strength of recommendation. Strong recommendations use "should do" phrasing, or phrasing implying an expectation to perform the recommended action for most patients. Weak recommendations use "consider" or "suggested" phrasing. Recommendations are explicitly labeled as Strong recommendations or Weak recommendations when a qualified group has explicitly deliberated on making such a recommendation. Group deliberation may occur during guideline development. When group deliberation occurs through DynaMed-initiated groups: Clinical questions will be formulated using the PICO Population, Intervention, Comparison, Outcome framework for all outcomes of interest specific to the recommendation to be developed.
Systematic searches will be conducted for any clinical questions where systematic searches were not already completed through DynaMed content development. Evidence will be summarized for recommendation panel review including for each outcome, the relative importance of the outcome, the estimated effects comparing intervention and comparison, the sample size, and the overall quality rating for the body of evidence.
Recommendation panel members will be selected to include at least 3 members that together have sufficient clinical expertise for the subject s pertinent to the recommendation, methodological expertise for the evidence being considered, and experience with guideline development. All recommendation panel members must disclose any potential conflicts of interest professional, intellectual, and financial , and will not be included for the specific panel if a significant conflict exists for the recommendation in question.
Panel members will make Strong recommendations if and only if there is consistent agreement in a high confidence in the likelihood that desirable consequences outweigh undesirable consequences across the majority of expected patient values and preferences. Panel members will make Weak recommendations if there is limited confidence or inconsistent assessment or dissenting opinions that desirable consequences outweigh undesirable consequences across the majority of expected patient values and preferences.
No recommendation will be made if there is insufficient confidence to make a recommendation. All steps in this process including evidence summaries which were shared with the panel, and identification of panel members will be transparent and accessible in support of the recommendation. Recommendations are published only after consensus is established with agreement in phrasing and strength of recommendation by all editors.
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If consensus cannot be reached then the recommendation can be published with a notation of "dissenting commentary" and the dissenting commentary is included in the topic details. If recommendations are questioned during peer review or post publication by a qualified individual, or reevaluation is warranted based on new information detected through systematic literature surveillance, the recommendation is subject to additional internal review.
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All editorial team members and reviewers have declared that they have no financial or other competing interests related to this topic, unless otherwise indicated. Special acknowledgements DynaMed topics are written and edited through the collaborative efforts of the above individuals.
All articles used in the formulation of this clinical policy were graded by at least 2 subcommittee members and assigned a Class of Evidence. In doing so, subcommittee members assigned design classes to each article, with design 1 representing the strongest study design and subsequent design classes e.
Articles were then graded on dimensions related to the study's methodological features, including but not necessarily limited to randomization processes, blinding, allocation concealment, methods of data collection, outcome measures and their assessment, selection and misclassification biases, sample size, and generalizability. Using predetermined formulas related to the study's design, methodological quality, and applicability to the critical question, articles received a final Class of Evidence grade i. Articles identified with fatal flaws or that were not applicable to the critical question received a Class of Evidence grade "X" and were not used in formulating recommendations for this policy.
Grading was done with respect to the specific critical questions; thus, the level of evidence for any one study may vary according to the question. As such, it was possible for a single article to receive different Classes of Evidence as different critical questions were answered from the same study. Question-specific Classes of Evidence grading may be found in the Evidentiary Table at the end of the original guideline document.
This policy is a product of the American College of Emergency Physicians ACEP clinical policy development process, including expert review, and is based on the existing literature; where literature was not available, consensus of emergency physicians was used. Their responses were used to further refine and enhance this policy; however, their responses do not imply endorsement of this clinical policy. Clinical policy: procedural sedation and analgesia in the emergency department.
Ann Emerg Med. Writing Committee Members : Steven A. Burton, MD; Charles J. Gerardo, MD; Benjamin W. Hatten, MD; Sharon E. Mace, MD; Scott M. Silvers, MD; Francis M. Fesmire, MD Committee Chair. Oversight Committee Members : Francis M. Burton, MD; Deborah B. Godwin, MD; Sigrid A. Hahn, MD; Jason S. Mace, MD; Edward R. Melnick, MD; Devorah J. Nazarian, MD; Susan B. Promes, MD; Richard D. Shih, MD; Scott M. Silvers, MD; Stephen J. Wolf, MD; Stephen V.
Procedural sedation in emergency medicine
Relevant industry relationships: Dr. Relevant industry relationships are those relationships with companies associated with products or services that significantly impact the specific aspect of disease addressed in the critical question. The information was verified by the guideline developer on March 28, Food and Drug Administration advisory on antiepileptic drugs.
The updated information was verified by the guideline developer on April 15, Food and Drug Administration advisory on Opioid pain medicines. This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. Emergent and urgent conditions that require procedural sedation with or without analgesia in the emergency department ED. All guidelines summarized by NGC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public or private organizations, other government agencies, health care organizations or plans, and similar entities.
NGC, AHRQ, and its contractor ECRI Institute make no warranties concerning the content or clinical efficacy or effectiveness of the clinical practice guidelines and related materials represented on this site. Moreover, the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes.
Readers with questions regarding guideline content are directed to contact the guideline developer.
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A home for paediatricians. A voice for children and youth.
Search Content. Recently Added Please register or log in to create and use your library. Full Text Guideline Clinical policy: procedural sedation and analgesia in the emergency department. Recommendations Major Recommendations. In patients undergoing procedural sedation and analgesia in the emergency department ED , does preprocedural fasting demonstrate a reduction in the risk of emesis or aspiration? None specified. In patients undergoing procedural sedation and analgesia in the ED, does the routine use of capnography reduce the incidence of adverse respiratory events?
None specified In patients undergoing procedural sedation and analgesia in the ED, what is the minimum number of personnel necessary to manage complications? In patients undergoing procedural sedation and analgesia in the ED, can ketamine, propofol, etomidate, dexmedetomidine, alfentanil, and remifentanil be safely administered? Strength of recommendations regarding each critical question were made by subcommittee members using results from strength of evidence grading, expert opinion, and consensus among subcommittee members according to the following guidelines: Strength of Recommendations Level A recommendations.
Implementation of the Guideline Description of Implementation Strategy. Appropriate management of patients requiring procedural sedation and analgesia in the emergency department ED Appropriate monitoring of patients requiring procedural sedation and analgesia in the ED Avoidance of unnecessary delays for fasting prior to performance of procedural sedation in the ED, thus enabling more rapid patient management Appropriate and safe administration of moderate and deep sedatives used in procedural sedation in the ED Agents propofol and ketamine have been combined in studies in an effort to maximize benefits and limit unwanted side effects.