Smally Alan J, Nowicki Thomas Anthony
University of Connecticut Division of Emergency Medicine, Hartford Hospital, Hartford, CT 06102, USA.
Curr Opin Anaesthesiol. 2007 Aug;20(4):379-83. doi: 10.1097/ACO.0b013e32825a69f9.
The recent year's literature is reviewed concerning the use of sedation in the emergency department. The use of moderate to deep sedation is becoming common in emergency medicine for many reasons, including progressive hospital crowding, limited availability of anesthesia, and increased training in residency. This is performed for a wide variety of procedures, most commonly orthopedic.
The literature discussed medications, monitoring, and the safety of current sedation practice in the emergency department. Emergency department procedural sedation and analgesia is performed with a number of medications, including propofol, etomidate, midazolam, fentanyl, ketamine, and nitrous oxide. Cardiac monitoring, pulse oximetry and capnography are used, often without strong evidence-based support of need. Complications do occur and are higher in prospective studies than in retrospective series. This suggests a degree of underreporting. Nevertheless, clinically important complications are uncommon.
The year's literature reflects the reality that the performance of sedation in the emergency department is advantageous. As the era of evidence-based medicine continues to provide us with more and better information, the combined efforts of both anesthesiology and emergency medicine can hopefully contribute to improving patient safety with respect to procedural sedation.
回顾近年来有关急诊科镇静使用的文献。由于多种原因，包括医院日益拥挤、麻醉资源有限以及住院医师培训增加，中深度镇静在急诊医学中的使用越来越普遍。这用于多种操作，最常见的是骨科手术。
文献讨论了急诊科当前镇静实践中的药物、监测及安全性。急诊科程序性镇静和镇痛使用多种药物，包括丙泊酚、依托咪酯、咪达唑仑、芬太尼、氯胺酮和氧化亚氮。使用了心脏监测、脉搏血氧饱和度测定和二氧化碳描记法，但其必要性往往缺乏有力的循证支持。并发症确实会发生，前瞻性研究中的发生率高于回顾性系列研究。这表明存在一定程度的漏报情况。然而，具有临床意义的并发症并不常见。
当年的文献反映了急诊科进行镇静具有优势这一现实。随着循证医学时代继续为我们提供更多更好的信息，麻醉学和急诊医学的共同努力有望在程序性镇静方面提高患者安全性。
