CanadiEM Podcasts: CRACKCast, ClerkCast, CarmsCast, First Year Diaries CRACKCast E004 - Procedural Sedation and Analgesia
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Feb 4, 2016 A fast-paced run through procedural sedation and analgesia: sedation levels from minimal to general, dissociation, and ED targets. Practical prep, monitoring needs, staffing and airway risk assessment. Drug comparisons covering fentanyl, midazolam, ketamine, propofol, etomidate, ketofol and nitrous oxide. Recovery, discharge rules, contraindications and common complications with management tips.
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Know The Five Core Sedation Drugs
- Five commonly used PSA agents are fentanyl, midazolam, ketamine, propofol, and etomidate, each with distinct onset, duration, and adverse profiles.
- Fentanyl for analgesia; midazolam for anxiolysis/seizures; ketamine preserves airway reflexes; propofol is rapid short acting; etomidate has minimal hemodynamic effect.
Ketamine Dosing And Key Risks
- For ketamine dosing use 1–2 mg/kg IV or 4–5 mg/kg IM in children with 1–5 minute onsets and 15–30 minute durations for IM.
- Benefit: airway reflexes usually preserved; risk: emergence reactions (~15%) and rare laryngospasm (~0.4%).
Propofol Requires Dose Tailoring And Caution
- For propofol start low in elderly and be aggressive in kids; typical IV range 0.5–2 mg/kg with 30–60 second onset and ~10 minute duration.
- Watch for respiratory depression, hypotension, injection pain, and loss of airway reflexes.
