Procedural Sedation Medications

The June issue of Emergency Medicine Practice is on the topic of Procedural Sedation and Analgesia in the Emergency Department. It includes an exhaustive review of both adult and pediatric procedural sedation. Table 2 of the publication is reproduced below for your rapid reference.


Table 2: Routinely Available Agents and Dosages for Emergency Department Procedural Sedation1

AgentStarting Dosage, Adult
and Pediatric Patients
Onset (min)Duration  (min)AdvantagesDisadvantages
Fentanyl1 mcg/kg IV1-230-40•Rapid onset
•Short duration
•Minimal CV effects
•Chest wall rigidity (when given
rapidly in large doses)
•Analgesic properties only
Remifentanil0.05-0.1 mcg/kg/
min IV infusion with
supplemental 0.5-1
mcg/kg IV boluses
<1-33-10•Short duration
•Can be titrated
•Respiratory depression
•Analgesic properties only
Midazolam0.05-0.1 mg/kg IV1.560-120•Rapid onset
•Short duration
•Multiple routes
•Respiratory depression
•Moderate duration
•Sedative properties only
Nitrous Oxide30%-70% concentration1-23-5•Rapid onset
•Minimal CV effects
•Emesis
•Expansion of gas-filled
structures
Propofol0.5-1 mg/kg IV<13-10•Rapid onset
•Antiemetic
•Short duration
•Hypotension
•Respiratory depression
•Injection pain
•Sedative properties only
Ketamine•1-1.5 mg/kg IV
•4-5 mg/kg IM
•6-9 mg/kg IN (adults only)
~1 (IV)
~5 (IM)
10-15 (IV)
15-30 (IM)
•Preserved airway reflexes
•Predictable
•Provides analgesia and sedation
•Emergence phenomena
•Emesis
•Laryngospasm
•Hypertension
•Tachycardia
•Increased secretions
Ketofol
Ketamine +
Propofol
(adult
patients
only)
1.1 admixture dosing
0.5 mg/kg ketamine IV
and 0.5 mg/kg propofol IV administered
simultaneously
1-310-15•Airway preservation
•Hemodynamic stability
•Rapid recovery
•Use together offsets hemodynamic
effects of each individual agent
•Provides analgesia and sedation
Same as for each individual
Etomidate0.15 mg/kg IV<15-10•Rapid onset
•Minimal CV effects
•Respiratory depression
•Myoclonus
•Sedative properties only
Abbreviations: CV, cardiovascular; IM, intramuscular; IN, intranasal; IV, intravenous.
Source: Kern J, Guinn A, Mehta P. Procedural sedation and analgesia in the emergency department. Emerg Med Pract. 2022 Jun;24(6):1-24. Epub 2022 Jun 1. PMID: 35616493.

Further Reading

Procedural Sedation and Analgesia in the Emergency Department (Pharmacology CME)

Date Release: Jun 2022

Procedural sedation and analgesia are essential in emergency medicine. This issue reviews how to choose the optimal agents and procedures, individualized for each patient.

Ultrasound-Guided Pediatric Nerve Blocks in the Emergency Department: An Evidence-Based Update (Pain Management CME and Pharmacology CME)

Date Release: May 2022

This issue discusses materials, methods, and monitoring for pediatric patients undergoing nerve blocks in the emergency department. Recognition and management of local anesthetic systemic toxicity syndrome and special considerations for pediatric patients are also reviewed.


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References

  1. Godwin SA. Procedural sedation and analgesia. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. Ninth ed. Philadelphia, PA: Elsevier; 2018
  2. Kern J, Guinn A, Mehta P. Procedural sedation and analgesia in the emergency department. Emerg Med Pract. 2022 Jun;24(6):1-24. Epub 2022 Jun 1. PMID: 35616493.

Last Updated on June 8, 2022

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