Requirement for Discharge in the Care of a Responsible Adult in Procedural Sedation in the Emergency Department: Necessity or Potential Barrier to Health Equity?
J Emerg Med
; 65(4): e272-e279, 2023 10.
Article
in En
| MEDLINE
| ID: mdl-37679283
ABSTRACT
BACKGROUND:
Procedural sedation is commonly practiced by emergency physicians to facilitate patient care in the emergency department (ED). Although various guidelines have modernized our approach to procedural sedation, many procedural sedation guidelines and practices still often require that patients be discharged into the care of a responsible adult.DISCUSSION:
Such requirement for discharge often cannot be met by underserved and undomiciled patients. Benzodiazepines, opioids, propofol, ketamine, "ketofol," etomidate, and methohexital have all been utilized for procedural sedation in the ED. For patients who may require discharge without the presence of an accompanying responsible adult, ketamine, propofol, methohexital, "ketofol," and etomidate are ideal agents for procedural sedation given rapid onsets, short durations of action, and rapid recovery times in patients without renal or hepatic impairment. Proper pre- and postprocedure protocols should be utilized when performing procedural sedation to ensure patient safety. Through the use of appropriate medications and observation protocols, patients can safely be discharged 2 to 4 h postprocedure.CONCLUSION:
There is no pharmacodynamic or pharmacokinetic basis to require discharge in the care of a responsible adult after procedural sedation. Thoughtful medication selection and the use of evidence-based pre- and postprocedure protocols in the ED can help circumvent this requirement, which likely disproportionally impacts patients who are of low socioeconomic status or undomiciled.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Propofol
/
Health Equity
/
Etomidate
/
Ketamine
Type of study:
Guideline
/
Qualitative_research
Aspects:
Equity_inequality
Limits:
Adult
/
Humans
Language:
En
Journal:
J Emerg Med
Journal subject:
MEDICINA DE EMERGENCIA
Year:
2023
Document type:
Article