Volume 8 Number 8 2024
Best Practices in Procedural Sedation and Analgesia (PSA) in the Emergency Department: A Review Study
Ibrahim Saad Al-Dosari 1*, Khaled Manaja Almutairi 1, Hani Ahmed Alshehri 1, Saeed Ali Aljarman Alshrany 1, Abdullah Mukhlef J. Alanazi 1, Abdullah Ghazi Alsuqmi Alruwaili 1, Meshal Ibrahim Zaid ALOwias 1, Jehan saleh Mohammed Rae Alqudah 1
Journal of Angiotherapy 8 (8) 1-8 https://doi.org/10.25163/angiotherapy.8810404
Submitted: 27 May 2024 Revised: 13 August 2024 Accepted: 15 August 2024 Published: 15 August 2024
Abstract
Background: Procedural sedation and analgesia (PSA) is a critical intervention in the emergency department (ED), enabling painful or anxiety-inducing procedures while also maintaining patient safety and comfort. Although widespread, practice variations and potential adverse events necessitate best practices that are standardized.
Aim: This review is intended to synthesize evidence-based best practices for PSA in the ED on the basis of patient evaluation, pharmacologic agents, monitoring, education, and management of adverse effects to achieve the best outcomes.
Methods: Peer-reviewed publications between 2016 and 2025 were extensively searched, including guidelines, systematic reviews, and clinical trials. Evidence was obtained from PubMed, Cochrane, and EMBASE.
Results: Key findings emerging indicate that PSA is safe (>99% success rate) when guided by protocols emphasizing pre-procedure risk stratification (e.g., ASA classification), agent-specific choice (e.g., ketamine in unstable patients), watchful capnography (reducing hypoxia by 52%), and inter-professional education. Severe adverse events such as intubation happen in <0.1% of procedures. Emergent developments such as remimazolam and AI-based monitoring are promising.
Conclusion: Standardized PSA protocols provide increased safety and efficacy in the ED. Future applications of new agents and technology will further improve outcomes, particularly for special populations such as pediatrics and geriatrics.
Keywords: Procedural sedation, emergency department, capnography, ketamine, adverse events.
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