Procedural sedation and analgesia at emergency department CHUK: Effectiveness and adverse events

Abstract

Procedural sedation and analgesia at emergency department CHUK: Effectiveness and adverse events. Introduction The emergency department is a place where procedures to save life are performed frequently first. Procedural Sedation and Analgesia (PSA) has to be used well and one who is performing the procedural sedation has to be able to handle adverse events. Different medications are used according their availability and based on performers experience and preference. Most reported adverse effects are hypotension, tachypnea, hypoxia, bradycardia, agitation, aspiration, vomiting, and apnea. Methods This study is a prospective observational study evaluating procedural sedation done in the university teaching hospital Kigali (CHUK) emergency department. We evaluate the effectiveness of sedation using the Richmond Agitation Sedation Score while under sedation, and pain scale before and after the procedure. We have evaluated the common adverse events related to PSA and associated them with the medications used as and the success or failure of the procedure. Results 251 patients were recruited. The majority were male (72 %) and female (28 %). The participants median age was 32 years (IQR23-40), youngest 8 years and oldest 88 years. The most commonly used analgesics included Morphine (78%), tramadol (17%), and ketamine least used at 1%. Commonest used for sedation included Ketamine (68%), Propofol (26%). Of procedures done in ED, 29% were for wash out with reduction of open fracture, followed by wound wash out only at 18%, shoulder dislocation (16%) , abscess incision and drainage and burn were (7%). Common adverse event was hypoxia (36%) followed by hallucination (8%), 47 % didn’t develop adverse events. There was no significant difference in success and failure rates between propofol and ketamine groups (P=0.518). There were no significant falls in HR, RR, SBP and SpO2 in either of the ketamine or propofol groups, or overall (P= 0.04-0.9). There were no significant falls in HR, RR, SBP and SpO2 in either of the ketamine or propofol groups, or overall (P= 0.04-0.9) . All adverse events were managed successfully by operator or with the help of a supervisor. Conclusion The results found was similar to other studies done in developing country where hypoxia was the leading cause of adverse events. Procedural sedation can be done in low-income setting with good preparation to manage adverse events.