Smits Gaël Jp, Kuypers Maybritt I, Mignot Lisette Aa, Reijners Eef Pj, Oskam Erick, Van Doorn Karen, Thijssen Wendy Amh, Korsten Erik Hm
Emergency Department, Catharina Hospital, Eindhoven, The Netherlands.
Emergency Department, Tergooi Ziekenhuis, Hilversum, The Netherlands.
Emerg Med J. 2017 Apr;34(4):237-242. doi: 10.1136/emermed-2016-205767. Epub 2016 Oct 21.
To describe our experience performing ED procedural sedation in a country where emergency medicine (EM) is a relatively new specialty.
This is a prospective observational study of adult patients undergoing procedural sedation by emergency physicians (EPs) or EM residents in eight hospitals in the Netherlands. Data were collected on a standardised form, including patient characteristics, sedative and analgesic used, procedural success, adverse events (classified according to World SIVA) and rescue interventions.
1711 adult cases were included from 2006 to 2013. Propofol, midazolam and esketamine (S+ enantiomer of ketamine) were the most used sedatives (63%, 29% and 8%). We had adverse event data on all patients. The overall adverse event rate was 11%, mostly hypoxia or apnoea. There was no difference in adverse event rate between EPs and EM residents. However, there was a significantly higher success rate of the procedure when EPs did the procedural sedation (92% vs 84%). No moderate (unplanned hospital admission or escalation of care) or sentinel SIVA outcomes occurred (pulmonary aspiration syndrome, death or permanent neurological deficit).
Adverse events during procedural sedation occurred in 11% of patients. There were no moderate or sentinel outcomes. All events could be managed by the sedating physician. In a country where EM is a relatively new specialty, procedural sedation appears to be safe when performed by EPs or trained EM residents and has comparable adverse event rates to international studies.
描述在一个急诊医学（EM）作为相对较新专业的国家进行急诊程序镇静的经验。
这是一项对荷兰八家医院中由急诊医生（EPs）或急诊医学住院医师进行程序镇静的成年患者的前瞻性观察研究。数据通过标准化表格收集，包括患者特征、使用的镇静剂和镇痛药、程序成功率、不良事件（根据世界SIVA分类）和抢救干预措施。
纳入了2006年至2013年的1711例成年病例。丙泊酚、咪达唑仑和艾司氯胺酮（氯胺酮的S +对映体）是最常用的镇静剂（分别为63%、29%和8%）。我们有所有患者的不良事件数据。总体不良事件发生率为11%，主要是低氧或呼吸暂停。EPs和急诊医学住院医师之间的不良事件发生率没有差异。然而，当EPs进行程序镇静时，程序成功率显著更高（92%对84%）。没有发生中度（计划外住院或护理升级）或严重的SIVA结果（肺误吸综合征、死亡或永久性神经功能缺损）。
11%的患者在程序镇静期间发生不良事件。没有中度或严重的结果。所有事件均可由实施镇静的医生处理。在一个急诊医学作为相对较新专业的国家，由EPs或经过培训的急诊医学住院医师进行程序镇静似乎是安全的，且不良事件发生率与国际研究相当。
