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Procedural sedation in the emergency department by Dutch emergency physicians: a prospective multicentre observational study of 1711 adults
  1. Gaël JP Smits1,
  2. Maybritt I Kuypers2,
  3. Lisette AA Mignot3,
  4. Eef PJ Reijners4,
  5. Erick Oskam5,
  6. Karen Van Doorn6,
  7. Wendy AMH Thijssen1,
  8. Erik HM Korsten7
  1. 1Emergency Department, Catharina Hospital, Eindhoven, The Netherlands
  2. 2Emergency Department, Tergooi Ziekenhuis, Hilversum, The Netherlands
  3. 3Emergency Department, Maxima Medical Centre, Veldhoven, The Netherlands
  4. 4Emergency Department, St. Elisabeth Hospital, Tilburg, The Netherlands
  5. 5Emergency Department, Albert Schweitzer Hospital, Dordrecht, The Netherlands
  6. 6Emergency Department, Medisch Centrum Haaglanden, The Hague, The Netherlands
  7. 7Department of Anaesthesiology, Intensive Care and Pain Catharina Hospital, Eindhoven, The Netherlands
  1. Correspondence to Dr Gaël JP Smits, Emergency Department, Catharina Hospital, P.O. Box 1350, Eindhoven 5602 ZA, The Netherlands; gael.smits{at}


Objective To describe our experience performing ED procedural sedation in a country where emergency medicine (EM) is a relatively new specialty.

Methods This is a prospective observational study of adult patients undergoing procedural sedation by emergency physicians (EPs) or EM residents in eight hospitals in the Netherlands. Data were collected on a standardised form, including patient characteristics, sedative and analgesic used, procedural success, adverse events (classified according to World SIVA) and rescue interventions.

Results 1711 adult cases were included from 2006 to 2013. Propofol, midazolam and esketamine (S+ enantiomer of ketamine) were the most used sedatives (63%, 29% and 8%). We had adverse event data on all patients. The overall adverse event rate was 11%, mostly hypoxia or apnoea. There was no difference in adverse event rate between EPs and EM residents. However, there was a significantly higher success rate of the procedure when EPs did the procedural sedation (92% vs 84%). No moderate (unplanned hospital admission or escalation of care) or sentinel SIVA outcomes occurred (pulmonary aspiration syndrome, death or permanent neurological deficit).

Conclusion Adverse events during procedural sedation occurred in 11% of patients. There were no moderate or sentinel outcomes. All events could be managed by the sedating physician. In a country where EM is a relatively new specialty, procedural sedation appears to be safe when performed by EPs or trained EM residents and has comparable adverse event rates to international studies.

  • analgesia/pain control
  • anaesthesia
  • effectiveness

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors GJPS and MIK conceived the study and GJPS undertook recruitment of participating centres. GJPS, MIK, LAAM, EPJR, EO, KVD and WAMHT acquired the data. GJPS managed the data. MIK, WAMHT and EHMK helped with analysing and interpreting the data. GJPS drafted the manuscript. All authors contributed substantially to its revisions. GJPS takes responsibility for the paper as a whole.

  • Competing interests None.

  • Ethics approval Catharina Hospital Institutional Review Board.

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

  • Data sharing statement We also collected the variable ‘difficulty of the procedure’ (easy–normal–difficult) rated by the physician. This was filled in only 350 of 1711 cases. Available as SPSS file, by emailing the corresponding author.

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