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Abstracts of Posters Presented at the International Anesthesia Research Society; 72nd Clinical and Scientific Congress; Orlando, FL; March 7-11, 1998: Education & Patient Safety

ER SEDATION PRACTICES

ARE THEY SAFE?

BARNES, SD MD; SIKAVITSAS, A DO

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doi: 10.1097/00000539-199802001-00157
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Abstract S158

Practice guidelines for sedation & analgesia by non-anesthesiologists have recently been reported by the ASA task force. [1] We conducted a telephone survey study of ER sedation practices in a large metropolitan area to determine if sedation guidelines were in place & if these guidelines were consistent with published guidelines. [1]

METHODS: The study involved both university & community based ER's. The ER director or person in charge was surveyed. The visits per year, percent pediatrics, & total daily attending coverage was noted. Questions were asked concerning the presence of a sedation policy or guidelines, reasons for formulating said policy, & persons involved in policy formulation. The common sedatives used for painful & non-painful procedures were noted. Specific inquiry was made regarding NPO guidelines & whether these guidelines were altered with different levels of sedation.

RESULTS: There were a total of 32 ER's surveyed, 10 university and 22 community based. The average visits per year were approximately 30 thousand with 20-30 percent pediatric cases. The duration of attending coverage was 16-24 hrs. 28 (88%) of the hospitals contacted had a sedation policy or guidelines. The most common reasons for policy formulation were JCAHO requirement (44%) & patient safety concerns (38%). The persons most often involved with policy formulation were emergency medicine (63%) and anesthesia (47%). The most frequently used sedatives for painful procedures were midazolam and fentanyl, with chloral hydrate and midazolam used commonly for non-painful procedures. Ketamine was used by 7 (22%) of the ER's surveyed. 13 (40%) of the ER's surveyed did not have NPO guidelines & those with NPO guidelines did not strictly enforce them. The most common NPO time was 3-4 hrs (31%), with 16% less than 2 hrs, & only 1 ER stated that their NPO guideline was 6 hrs.

DISCUSSION: Although several limitations are inherent in a study such as this, the results raise some important issues. Sedation guidelines are widely published, especially when pediatric patients are involved, [1,2] but our data suggest that these guidelines often are not followed in the high-risk emergent patient. Even though most of the ER's surveyed had a sedation policy in place, many either did not include NPO guidelines, or the NPO guidelines were not always followed. Sedation disasters have recently been documented. [3] We should continue to work towards the institution of safe sedation practices in ER's and other out-patient settings.

REFERENCES

1. Anesthesiology 84:459, 1996
2. Pediatrics 89:1110, 1992
3. Anesthesiology 83:A1193, 1995.
© 1998 International Anesthesia Research Society