Contemporary sedation practice in a large New Zealand emergency department

Abstract

Aim: Procedural sedation is commonly employed in the emergency department to assist in performance of noxious or invasive procedures. Numerous studies exist purporting the safety and efficacy of procedural sedation in North America and Australia, however, little data on sedation practice within New Zealand has been reported. We present one-year experience of all procedural sedations performed at Waikato Hospital.

Method: A prospective audit of all procedural sedations performed at the emergency department of Waikato hospital during the 2009 calendar year was conducted. Data abstraction included: indication for sedation, procedure duration, emergency department length of stay, required personnel, and procedural success, in addition to sedative agents employed and associated adverse events.

Results: 589 (276 paediatric, 313 adult) episodes of procedural sedation were available for analysis. Successful procedure performance was reported in 98% of paediatric cases and 88% of adult cases. Ketamine was the most commonly employed agent in the paediatric population (83.6%), with propofol the most frequently used in adults (99%). Procedural duration and emergency department length of stay was median 15 (IQR 10-25) minutes, and 122 (IQR 85-164) minutes respectively for the paediatric group, and median 15 (IQR 10-20) minutes and 124 (81-192) minutes for adult patients. Discharge rates for paediatric and adult patients were 87% and 52% respectively. Complication rates of procedural sedation for both groups was low.

Conclusion: Procedural sedation appears both safe and effective in performance of time-limited noxious manipulations in a 'real-life' emergency department setting in New Zealand.