Background

In sedation medications are used to relax, calm, and induce sleep during procedure/surgery in any patient. 

Treating pain and anxiety in ED it is necessary to maintain satisfaction and quality of care. Sedation reduces patient awareness and responsiveness to the environment and external stimuli during treatment. 

Physicians need to determine the required sedation dose and correct medication before administration. 

Types of Sedation: 

Minimal Sedation 

Moderate Sedation 

Deep Sedation 

General Anesthesia 

Medication used in sedation: 

Benzodiazepines: 

E.g., Midazolam, Diazepam 

Barbiturates: 

E.g., Phenobarbital, Pentobarbital 

Opioids: 

E.g., Fentanyl, Morphine 

Nonopioid analgesic: 

E.g., Ketamine 

Indications

Sedation is used in following cases:  

Endoscopy/Colonoscopy 

Minor Surgical Procedures 

Dental Procedures 

Diagnostic Imaging 

Emergency Medicine 

Fracture Reduction 

Laceration Repair 

Abscess Drainage 

Mechanical Ventilation 

Procedures in ICU 

Pediatrics 

Imaging Studies 

Contraindications

Absolute Contraindications are: 

Allergy or Hypersensitivity 

Severe Cardiopulmonary Conditions are: 

Acute Head Injury with Increased Intracranial Pressure 

Severe Liver or Kidney Dysfunction 

Severe Obesity 

Pregnancy 

History of Substance Abuse 

Mental Health Disorders 

Coagulopathy or Anticoagulant Therapy 

Situational and Procedural Contraindications are: 

Inadequate Fasting 

Lack of Proper Monitoring and Resuscitation Equipment 

Outcomes

Decreased anxiety, pain, distress, improved patient cooperation in uncomfortable procedures. 

Short-acting sedatives enable quick recovery, minimal sedation residuals, shorter hospital stay, and faster outpatient discharge. 

Sedatives may cause memory loss, while respiratory depression may lead to hypoventilation and hypoxemia during sedation. 

Sedative medicines can cause hypotension, bradycardia, arrhythmias, and cardiac arrest also shows prolonged effects in liver or kidney dysfunction patients. 

Equipment required

Monitoring Equipment 

Non-Invasive Blood Pressure Monitor 

Airway Management Equipment 

Respiratory Rate Monitor 

Intravenous Access and Administration Equipment 

Patient Preparation

Informed Consent:  

Based on patient’s health status, procedure, and level of sedation explain in detail to get consent from patient. 

Patient Positioning

Patient should lay down in supine position as per procedure/surgery.  

         Fig. Sedation before procedure  

Technique

Step 1: Administration of sedation: 

Oral Sedation:  

Administer the prescribed medication with water. 

Inhalation Sedation:  

Start with a low concentration of nitrous oxide, then adjust as per patient comfort. 

IV Sedation:  

Begin with a low dose, titrate with effect while monitoring patient response. 

IM Sedation:  

Administer the appropriate dose based on weight and desired sedation level. 

Step 2: patient monitoring  

Monitor heart rate, blood pressure, respiratory rate, and oxygen saturation. 

Use sedation scales to assess and document sedation depth. 

Complications

Respiratory Complications: 

Respiratory Depression 

Airway Obstruction 

Hypoxemia 

Cardiovascular Complications: 

Hypotension 

Bradycardia 

Arrhythmias 

Neurological Complications: 

Paradoxical Reactions 

Allergic and Hypersensitivity Reactions 

Anaphylaxis 

Gastrointestinal Complications: 

Nausea and Vomiting 

Aspiration 

References

Procedural Sedation – StatPearls – NCBI Bookshelf (nih.gov) 

References

Procedural Sedation – StatPearls – NCBI Bookshelf (nih.gov)