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.