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Recall after procedural sedation in the emergency department
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  1. Alex Swann1,
  2. Jeffrey Williams2,
  3. Daniel M Fatovich3
  1. 1Department of Anaesthesia, Royal Perth Hospital, Perth, Western Australia, Australia
  2. 2Emergency Department, Royal Perth Hospital, Perth, Western Australia, Australia
  3. 3University of Western Australia, Perth, Western Australia, Australia
  1. Correspondence to:
 Dr A Swann
 Department of Anaesthesia, Royal Perth Hospital, Box X2213 GPO, Perth WA 6847, Australia; alexswann{at}doctors.org.uk

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.

  • ED, emergency department
  • PS, procedural sedation
  • VAS, visual analogue scale

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Footnotes

  • Competing interests: None declared.

  • Presented at: Australasian College for Emergency Medicine, 2006 Winter Symposium, Townsville, 29 June to 2 July 2006.

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