Unfortunately, it is a very complicated situation that doesn't have one cookie cutter answer. Clinical situations, availability of resuscitative equipment and personnel, etc. will determine the success or failure of an ER's sedation protocol.VJV said:We are looking at having ED MDs do deep sedation in ED with induction agents (etomidate, propofol) and was wondering what was happening at other institutions. This is not currently done in our medical community and we are a little hesitant.
You're wise to be a little wary. This debate is raging in many different areas.VJV said:We are looking at having ED MDs do deep sedation in ED with induction agents (etomidate, propofol) and was wondering what was happening at other institutions. This is not currently done in our medical community and we are a little hesitant.
Same questions - who gives it, who monitors, who does the sedating?2ndyear said:I routinely see peds intensivists here (no anes residency) give propofol for procedural sedation. I know they're not anesthesiologists but they are quite competent.
On another note we also have an outcomes based survey that goes in the chart for any sedative/hypnotic used by non-anesthesia personnel. It asks questions about any adverse events, etc. This is mainly for things like caths, bronchs, other scopes, etc.
There has been a few adverse outcomes, so far I've seen it in peds patients, where you don't want to wait for the peds sedation team as you have to schedule about a week in advance, the anesthesiologists are tied up in the OR, so someone slips them too much versed and they code in the CT scanner.
"Deep Conscious Sedation" is an oxymoron - it doesn't exist.kungfufishing said:propofol is great stuff though, and I would say if you are going to choose an agent for deep conscious sedation in an ED setting *most* of the time, it is a great choice - short half life, effective, fat calorie source if your patient is a malnourished alkie frequent flyer