• Özgür Karcıoğlu
  • Niyazi Özüçelik
  • Figen Coşkun
  • Cüneyt Ayrık
  • Ahmet Demircan

Eurasian J Emerg Med 2003;2(1):16-20

Emergency physicians frequently take part in various painful procedures in which the patient needs sedation and analgesia. Concious sedation is a state in which the protective airway reflexes are spared while the patient's awareness of the external stimuli is markedly depressed. In the emergency department, this is accomplished after obtaining the patient's informed consent and after implementing proper bedside monitoring and full recording of all events during the procedure. In most situations, the suitable combination for procedural sedation consists of a short-acting benzodiazepine (midazolam) and a potent opioid (e.g. fentanyl). Two absolute contraindications of concious sedation are refusal of the patient and hemodynamic instability. Midazolam is the drug of choice due to its short duration of action, making it useful for short procedures such as reduction of dislocations. The drug is also preferred because of its safe profile and predictability of effects. Flumazenil is used to reverse any unwanted side effects, such as respiratory depression. This article highlights the indications, effects, and side-effects of medications commonly used for procedural sedation in the emergency department.

Keywords: Procedural sedation, benzodiazepines, midazolam, emergency department