When is sedation indicated in the emergency department (ED) setting?

Updated: Nov 06, 2018
  • Author: Arul M Lingappan, MD; Chief Editor: Erik D Schraga, MD  more...
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The therapeutic goals of sedation in the ED must constantly be considered before, during, and after the process to ensure the necessity and adequacy of anesthesia. The clinician must weigh the potential for pain and discomfort of a given procedure with the risks that might be associated with sedative medications. However, clinicians should not withhold needed analgesia or sedation, especially in particularly painful or stressful procedures. Doses can always be adjusted as the clinical situation demands.

Numerous indications exist for sedation; invasive procedures are highly stressful and should at least prompt consideration of sedation. Even minor procedures routinely performed without sedation, such as lumbar puncture, may be facilitated and performed with more patient comfort when sedatives are administered. Rapid-sequence endotracheal intubation in a patient who is not in arrest is another indication for sedation, often used in conjunction with paralytics. If neuromuscular blockers/paralytics are used, adequate sedation is an absolute requirement. An agitated or confused patient who does not respond to reassurance is another candidate for sedation, particularly if the patient has cardiopulmonary compromise that is affected by physiologic stress.

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