Wood-Thompson Delecia K, Enyuma Callistus O A, Laher Abdullah E
Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Department of Paediatrics, Faculty of Medicine, University of Calabar, Nigeria.
Afr J Emerg Med. 2019 Mar;9(1):8-13. doi: 10.1016/j.afjem.2018.09.003. Epub 2018 Oct 13.
Procedural sedation and analgesia allows the clinician to safely and efficiently administer sedation, analgesia, anxiolysis and sometimes amnesia to facilitate the performance of various procedures in the emergency centre. The aim of this study is to determine current sedation practices, common indications and major obstacles in selected emergency centres across Southern Gauteng, South Africa, with a view to improving future standards and practices.
This was a prospective, questionnaire based, cross-sectional interview of emergency centre managers or their designee of selected private-sector and public-sector hospitals in Southern Gauteng.
Overall, 17 hospitals completed the interview, nine (53%) public-sector and eight (47%) private-sector hospitals, with 36% of hospitals being aligned to an academic institute. All hospitals performed procedural sedation in their emergency centre. Forty seven percent of managers had between ten and 19 years of clinical experience post internship. Although eleven (64.7%) managers achieved a postgraduate qualification in emergency medicine, only seven (41%) were accredited with a Fellowship of the College of Emergency Medicine (FCEM) qualification and only three (17.7%) centres employed three or more specialists. The majority of centres (52.3%) performed between ten and 30 procedures per month requiring sedation. Staff training in the practice of procedural sedation was mostly obtained internally (52.9%), from in-house seniors. Essential drugs, procedure monitors, resuscitation equipment and protocols were all available in 70.6% of centres.
Although the safe practice and awareness of procedural sedation and analgesia in both public-sector and private-sector emergency centres in Southern Gauteng appears to be on the increase, there is still a need to enhance practitioner training and promote awareness of current local and international trends, protocols and recommendations.
程序性镇静与镇痛使临床医生能够安全、高效地给予镇静、镇痛、抗焦虑，有时还能产生遗忘作用，以利于在急诊中心开展各种操作。本研究的目的是确定南非豪登省南部选定的急诊中心当前的镇静操作、常见适应症和主要障碍，以期提高未来的标准和操作水平。
这是一项针对豪登省南部选定的私立和公立医院的急诊中心管理人员或其指定人员进行的基于问卷的前瞻性横断面访谈。
总体而言，17家医院完成了访谈，其中9家（53%）为公立医院，8家（47%）为私立医院，36%的医院与学术机构有关联。所有医院的急诊中心都开展程序性镇静。47%的管理人员实习后有10至19年的临床经验。虽然11名（64.7%）管理人员获得了急诊医学研究生学历，但只有7名（41%）获得了急诊医学学院院士（FCEM）资格认证，只有3个（17.7%）中心雇佣了三名或更多专科医生。大多数中心（52.3%）每月进行10至30例需要镇静的操作。程序性镇静操作的人员培训大多是在内部（52.9%）从内部上级那里获得的。70.6%的中心备有基本药物、操作监测仪、复苏设备和操作流程。
尽管豪登省南部公立和私立急诊中心对程序性镇静与镇痛的安全操作和认识似乎在提高，但仍有必要加强从业者培训，并提高对当前本地和国际趋势、操作流程及建议的认识。
