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Procedural sedation and analgesia in a large UK Emergency Department: factors associated with complications
  1. Keith G Jacques1,
  2. Alistair Dewar2,
  3. Alasdair Gray2,
  4. Dean Kerslake2,
  5. Alexis Leal2,
  6. Fiona Lees3
  1. 1Emergency Department, Stirling Royal Infirmary, Stirling, Scotland, UK
  2. 2Emergency Department, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
  3. 3NHS National Services Scotland, Paisley, Scotland
  1. Correspondence to Dr Keith G Jacques, Consultant in Emergency Medicine, Stirling Royal Infirmary, Livilands, Stirling, FK8 2AU, UK; keith.jacques{at}


Background The aim of this study was to investigate the delivery of procedural sedation and analgesia (PSA) in an urban teaching hospital Emergency Department (ED) over a 2-year period, and identify factors associated with complications.

Methods Consecutive ED patients requiring PSA were prospectively enrolled onto the Registry of Emergency Procedural Sedation. Data collected included: patient and procedural characteristics; process times; physiological parameters; agents; sedation depth; and composition of staff team and complications. Multivariable binary logistic regression was used to identify factors associated with an increased risk of complications.

Results 1402 patents required PSA during the study period. 1345 (95.9%) underwent orthopaedic manipulations. 597 (42.6%) received moderate sedation. 401 (28.6%) were sedated to deeper levels. Complications occurred in 49 (3.5%) cases. Deeper levels of sedation and the procedure occurring overnight were identified as risk factors for complications. Procedure type, patient age, grade of doctor and choice of drug were not found to be associated with an increased risk of complications.

Conclusions Procedural sedation and analgesia by Emergency Physicians is safe and effective; however, complications do happen. Complications are more likely at deeper levels of sedation and at night. Emergency Physicians must have the necessary skills and equipment to deal with such complications when they arise. EDs must be adequately staffed with trained clinicians 24 h a day to provide PSA.

  • Moderate sedation
  • deep sedation
  • analgesia
  • emergency medicine
  • anaesthesia
  • analgesia/pain control
  • management, risk management

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  • Competing interests None.

  • Ethics approval This study was discussed with the Southeast Scotland Research Ethics Service, which classified it as service evaluation and therefore no formal ethical approval was required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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