Procedural sedation (Emergency Department)
Procedural sedation is the deliberate use of pharmacological agents to facilitate painful or distressing procedures while maintaining cardiorespiratory stability. Safe ED practice depends on appropriate patient selection, drug choice and titration, continuous monitoring (including capnography), airway rescue skills, informed consent, local governance and routine audit (RCEM 2022; NICE CG112).
Aims
- Achieve the minimum depth of sedation required for the procedure.
- Maintain airway patency, adequate ventilation and haemodynamic stability.
- Minimise distress and complications, enable timely recovery and provide clear documentation and follow‑up.
Governance, staffing and training
- Local standard operating procedure (SOP) and sedation proforma must be available, and each ED should appoint a sedation lead and run routine audit (RCEM TROOPS recommended) to review practice and adverse events (RCEM 2022).
- Define local competency requirements and maintain training in sedation, airway management and resuscitation.
- Minimum team for uncomplicated adult sedation: sedationist (clinician competent in sedation and airway management), proceduralist and a dedicated nurse.
- Deep sedation or high‑risk cases require staff with higher airway/anaesthetic skills.
- Paediatric ketamine (RCEM): minimum of three dedicated staff (sedationist, proceduralist, experienced paediatric nurse).