Clinical Policy: Procedural Sedation and Analgesia in the
Emergency Department
October 20, 2004

I. What are the personnel requirements needed to provide
procedural sedation and analgesia in the ED?

Level C recommendations. During moderate and deep
sedation, a qualified support person should be present for
continuous monitoring of the patient.
Procedural sedation and analgesia in the ED must be
supervised by an emergency physician or other appropriately
trained and credentialed specialist.

II. What are the key components of the patient assessment
before initiating procedural sedation?

Level C recommendations. Obtain a history and perform
a physical examination to identify medical illnesses, medications,
allergies, and anatomic features that may affect procedural
sedation and analgesia and airway management.
No routine diagnostic testing is required before procedural
sedation.

III. Is preprocedural fasting necessary before initiating
procedural sedation?

Level C recommendations. Recent food intake is not
a contraindication for administering procedural sedation and
analgesia, but should be considered in choosing the timing and
target level of sedation.

IV. What equipment and supplies are required to provide
procedural sedation and analgesia?

Level C recommendations. Oxygen, suction, reversal agents,
and advanced life support medications and equipment should
be available when procedural sedation and analgesia is used.
Intravenous access should be maintained when intravenous
procedural sedation and analgesia is provided. Intravenous
access may not be necessary when procedural sedation and
analgesia is provided by other routes.

V. What assessment and monitoring are required to provide
procedural sedation in the ED?

Level C recommendations. Obtain and document vital signs
before, during, and after procedural sedation and analgesia.
Monitor the patient’s appearance and ability to respond to
verbal stimuli during and after procedural sedation and
analgesia.

VI. How should respiratory status be assessed?

Level B recommendations. Pulse oximetry should be used in
patients at increased risk of developing hypoxemia, such as
when high doses of drugs or multiple drugs are used, or when
treating patients with significant comorbidity.

Level C recommendations. When the patient’s level of
consciousness is minimally depressed and verbal communication
can be continually monitored, pulse oximetry may not be
necessary.
Consider capnometry to provide additional information
regarding early identification of hypoventilation.