Title:Procedural (Conscious) Sedation and Analgesia in Emergency Setting: How to
Choose Agents?
Volume: 29
Issue: 28
Author(s): Mustafa Ayan, Orhan Ozsoy, Sedat Ozbay, Canan Akman, Neslihan Ergun Suzer and Ozgur Karcioglu*
Affiliation:
- Department of Emergency Medicine, Taksim Education and Research Hospital,
University of Health Sciences, Istanbul, Turkey
Keywords:
Pain management, analgesia, sedation, procedural sedation, conscious sedation, drug.
Abstract: Pain has long been defined as an unpleasant sensory and emotional experience originating from any
region of the body in the presence or absence of tissue injury. Physicians involved in acute medicine commonly
undertake a variety of invasive and painful procedures that prompt procedural sedation and analgesia (PSA),
which is a condition sparing the protective airway reflexes while depressing the patient’s awareness of external
stimuli. This state is achieved following obtaining the patient’s informed consent, necessary point-ofcare
monitoring, and complete recording of the procedures. The most commonly employed combination for
PSA mostly comprises short-acting benzodiazepine (midazolam) and a potent opioid, such as fentanyl. The
biggest advantage of opioids is that despite all the powerful effects, upper airway reflexes are preserved and often
do not require intervention. Choices of analgesic and sedative agents should be strictly individualized and
determined for the specific condition. The objective of this review article was to underline the characteristics,
effectiveness, adverse effects, and pitfalls of the relevant drugs employed in adults to facilitate PSA in emergency
procedures.
