In addition, the prior Level C recommendation regarding preprocedural fasting is now a Level B recommendation and advises that providers “not delay procedural sedation in adults or pediatrics in the ED based on fasting time.”

In the years since the last policy, there has been increasing evidence published on the use of capnography with procedural sedation and analgesia. As a result, a Level B recommendation states that providers may use capnography as an adjunct to pulse oximetry and clinical assessment to detect hypoventilation earlier than pulse oximetry and/or clinical assessment alone.

As a call for future research, the policy authors note that ED studies on this topic should focus on patient-centered outcomes as a core principle in study design. They further suggest that studies should investigate best practices for procedural sedation, analgesia monitoring, and performance in high-risk patient subgroups.

In conclusion, ACEP’s revised policy provides supporting evidence for the unique expertise of emergency physicians regarding the performance of procedural sedation and analgesia, and can serve as a resource for emergency physicians to use within their home institutions and demonstrate recognition at a national level of this distinctive and specialized skill set.

Reference

1. Godwin SA, Burton JH, Gerardo CJ, et al. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2014;63(2):247–258.

Dr. Godwin is professor, chair, and chief of service for the department of emergency medicine and assistant dean of simulation education at the University of Florida College of Medicine at Jacksonville.