Department of Family Medicine, University of Cape Town, South Africa.
S Afr Med J. 2011 Nov 28;101(12):895-8.
To study the efficacy and safety of procedural sedation and analgesia (PSA) administered by medical officers (MOs) without formal anaesthetic training.
A retrospective descriptive study in the Emergency Department (ED) of False Bay Hospital (FBH), situated in the southern suburbs of the Cape Town Metro Health District. The study included all patients who received PSA at FBH between 1 March 2007 and 31 August 2009. Variables recorded included age, gender, physical status as determined by the American Society of Anesthesiologists (ASA status), procedure, fasting and intoxication status, PSA medications, adverse effects, rescue manoeuvres performed, if any, and time to discharge. Analysis was largely descriptive and clinical and demographic data are presented as means (standard deviations), medians, ranges and proportions as appropriate. Success of sedation and incidence of adverse effects are presented as proportions.
Of 166 patients, 140 (84.3%) showed a good level of sedation, 14 (8.4%) were inadequately sedated, 5 (3%) were too deeply sedated but showed no signs of respiratory compromise, and 7 (4.2%) developed respiratory side-effects. Respiratory complications were treated with simple airway manoeuvres; no patient required intubation or experienced respiratory problems after waking up. There was no significant difference in the risk of adverse effects between the fasted and non-fasted groups. Mildly intoxicated patients who received PSA were at a higher risk of adverse effects.
PSA can be administered safely by medical officers. Future research should expand on PSA research in this setting and focus on safety and patient satisfaction.
研究无正规麻醉培训的医师实施镇静镇痛程序（PSA）的疗效和安全性。
这是 False Bay 医院（FBH）急诊科的一项回顾性描述性研究，该医院位于开普敦大都市卫生区的南郊。该研究包括 2007 年 3 月 1 日至 2009 年 8 月 31 日期间在 FBH 接受 PSA 的所有患者。记录的变量包括年龄、性别、美国麻醉医师协会（ASA）确定的身体状况、程序、禁食和中毒状态、PSA 药物、不良反应、是否进行了抢救操作以及出院时间。分析主要是描述性的，临床和人口统计学数据以平均值（标准差）、中位数、范围和适当的比例表示。镇静效果的成功率和不良反应的发生率以比例表示。
在 166 名患者中，140 名（84.3%）镇静效果良好，14 名（8.4%）镇静不足，5 名（3%）镇静过深但无呼吸窘迫迹象，7 名（4.2%）出现呼吸副作用。呼吸并发症通过简单的气道操作进行治疗；没有患者需要插管或在醒来后出现呼吸问题。禁食和不禁食组不良反应的风险无显著差异。接受 PSA 的轻度中毒患者发生不良反应的风险更高。
医师可以安全地实施 PSA。未来的研究应在此背景下扩大 PSA 研究范围，并侧重于安全性和患者满意度。
