Recall after procedural sedation in the emergency department

Abstract

Background: Procedural sedation (PS) is common in the emergency department (ED) and ideally patients should have no recall of the procedure.

Aim: To determine the incidence of recall.

Methods: A prospective observational study in an university ED of all patients undergoing PS. Data were collected on a pre-formatted data sheet. Levels of satisfaction with the sedation by the treating physician and nurse were recorded on a 10 cm visual analogue scale. On recovery, the patient was asked a validated questionnaire to determine the rate of immediate recall and at telephone follow-up for delayed recall.

Results: 125 patients (88 male, 70%) were enrolled and 110 had completed follow-up. Mean (range) age was 51.6 (13–91) years. Procedures included 84 (67%) orthopaedic reductions and 41 (33%) cardioversions. A wide range of drug combinations were used, including fentanyl/propofol 32 (25.6%), fentanyl/midazolam 30 (24%), fentanyl/midazolam/propofol 16 (12.8%), propofol 13 (10.4%). 87.2% of procedures were successful. A grimace/groan was observed in 61 of 125 (49%). Immediate recall occurred in 9 of 121 (7.4%; 95% CI 3.7 to 14.0) and delayed recall in 5 of 110 (4.5%; 95% CI 1.7 to 10.8). No drug combination was correlated with recall (Spearman’s rho = 0.149), nor the presence of a grimace/groan (r = −0.039). Median sedation satisfaction scores were physician 9.0, nurse 10, patient 10. Correlation of delayed recall with patient satisfaction was –0.471 (p<0.001).

Conclusions: Recall following PS in ED is uncommon. There is no association of recall with drugs used or the presence of a grimace/groan. There is high patient satisfaction with PS in the ED.