Procedural Sedation and Analgesia Research
Abstract
The study of procedural sedation and analgesia has experienced significant development recently. As specific procedural sedation and analgesia agents have been developed and introduced into clinical practice, safety and efficacy studies have been conducted. The principle difficulty in conducting these studies has been the relatively low frequency of traditional outcome measures. As procedural sedation and analgesia research has expanded, measurement techniques have been refined to allow for precise comparisons between smaller groups of subjects to improve the capacity to compare these procedures. We have used capnography, bispectral EEG analysis, and subject perceptions of pain and recall as surrogate predictors of adverse events in order to compare agents and procedural techniques in procedural sedation and analgesia.
Key words
Procedural sedation and analgesia Research methodology Capnography Level of consciousness Oxygen saturation MonitoringReferences
- 1.Green SM, Krauss B (2004) Clinical practice guideline for emergency department ketamine dissociative sedation in children. Ann Emerg Med 44:460–71PubMedCrossRefGoogle Scholar
- 2.Miner JR et al (2007) The effect of the assignment of a pre-sedation target level on procedural sedation using propofol. J Emerg Med 32(3):249–55PubMedCrossRefGoogle Scholar
- 3.Miner JR, Biros M, Krieg S, Johnson C, Heegaard W, Plummer D (2003) Randomized clinical trial of propofol versus methohexital for procedural sedation during fracture and dislocation reduction in the emergency department. Acad Emerg Med 10:931–7PubMedCrossRefGoogle Scholar
- 4.Miner JR, Biros MH, Heegaard W, Plummer D (2003) Bispectral electroencephalographic analysis of patients undergoing procedural sedation in the emergency department. Acad Emerg Med 10:638–43PubMedGoogle Scholar
- 5.Miner JR, Biros MH, Seigel T, Ross K (2005) The utility of the bispectral index in procedural sedation with propofol in the emergency department. Acad Emerg Med 12:190–6PubMedCrossRefGoogle Scholar
- 6.Miner JR, Heegaard W, Plummer D (2002) End-tidal carbon dioxide monitoring during procedural sedation. Acad Emerg Med 9:275–80PubMedCrossRefGoogle Scholar
- 7.Burton JH, Harrah JD, Germann CA, Dillon DC (2006) Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices? Acad Emerg Med 13:500–4PubMedCrossRefGoogle Scholar
- 8.Avramov MN, White PF (1995) Methods for monitoring the level of sedation. Crit Care Clin 11:803–26PubMedGoogle Scholar
- 9.Miner JR, Danahy M, Moch A, Biros M (2007) Randomized clinical trial of etomidate versus propofol for procedural sedation in the emergency department. Ann Emerg Med 49(1):15–22PubMedCrossRefGoogle Scholar
- 10.Miner JR, Gaetz A, Biros MH (2007) The association of a decreased level of awareness and blood alcohol concentration with both agitation and sedation in intoxicated patients in the ED. Am J Emerg Med 25:743–8PubMedCrossRefGoogle Scholar
- 11.Deitch K, Chudnofsky CR, Dominici P (2007) The utility of supplemental oxygen during emergency department procedural sedation and analgesia with midazolam and fentanyl: a randomized controlled trial. Ann Emerg Med 49:1–8PubMedCrossRefGoogle Scholar
- 12.Krauss B, Hess DR (2007) Capnography for procedural sedation and analgesia in the emergency department. Ann Emerg Med 50:172–81PubMedCrossRefGoogle Scholar
- 13.Miner JR, Bachman A, Kosman L, Teng B, Heegaard W, Biros MH (2005) Assessment of the onset and persistence of amnesia during procedural sedation with propofol. Acad Emerg Med 12:491–6PubMedCrossRefGoogle Scholar
- 14.Miner JR, Martel ML, Meyer M, Reardon R, Biros MH (2005) Procedural sedation of critically ill patients in the emergency department. Acad Emerg Med 12:124–8PubMedCrossRefGoogle Scholar
- 15.Gill M, Green SM, Krauss B (2003) A study of the Bispectral Index Monitor during procedural sedation and analgesia in the emergency department. Ann Emerg Med 41:234–41PubMedCrossRefGoogle Scholar
- 16.Agrawal D, Feldman HA, Krauss B, Waltzman ML (2004) Bispectral index monitoring quantifies depth of sedation during emergency department procedural sedation and analgesia in children. Ann Emerg Med 43:247–55PubMedCrossRefGoogle Scholar
- 17.Bassett KE, Anderson JL, Pribble CG, Guenther E (2003) Propofol for procedural sedation in children in the emergency department. Ann Emerg Med 42:773–82PubMedCrossRefGoogle Scholar
- 18.Guenther E, Pribble CG, Junkins EP Jr, Kadish HA, Bassett KE, Nelson DS (2003) Propofol sedation by emergency physicians for elective pediatric outpatient procedures. Ann Emerg Med 42:783–91PubMedCrossRefGoogle Scholar
- 19.Vinson DR, Bradbury DR (2002) Etomidate for procedural sedation in emergency medicine. Ann Emerg Med 39:592–8PubMedCrossRefGoogle Scholar