Sedation in the emergency department: A complex and multifactorial challenge

Robert M. Kennedy

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

2 Scopus citations


Safe and effective management of procedure- related pain and anxiety in the emergency department (ED) has become expected. It facilitates controlled accomplishment of therapeutic and diagnostic procedures, reduces psychological trauma and its sequelae, reduces healthcare provider and parental distress, and improves parental acceptance of rendered care. Many advances in procedural sedation and analgesia (PSA) for nonelective procedures in non-fasted patients in the ED have occurred over the past 20 years as a result of intense interest in this concept and the development of general and pediatric emergency medicine specialties, for whom PSA is now considered core training. This chapter reviews some of the PSA techniques shown to safely and effectively decrease Childrens pain and anxiety associated with procedures in the ED. Since pain and anxiety are frequently indistinguishable, the combination will often be referred to as distress.

Original languageEnglish
Title of host publicationPediatric Sedation Outside of the Operating Room
Subtitle of host publicationA Multispecialty International Collaboration, Second Edition
PublisherSpringer New York
Number of pages56
ISBN (Electronic)9781493913909
ISBN (Print)9781493913893
StatePublished - Jan 1 2015


  • Adverse events
  • American College of Emergency Physicians
  • American Society of Anesthesiologists (ASA)
  • Anxiety
  • Atropine
  • Barbiturates
  • Capnography
  • Chloral hydrate
  • Codeine
  • Deep sedation
  • Dexamethasone (Decadron)
  • Diazepam
  • Diphenhydramine (Benadryl)
  • Emergency department
  • Emesis
  • Etomidate
  • Eutectic Mixture of Local Anesthetics (EMLA)
  • Fentanyl
  • Flumazenil
  • Flumazenil
  • Fospropofol
  • Gamma-aminobutyric acid (GABA)
  • Glycopyrrolate
  • Ketamine
  • Ketamine
  • Ketofol
  • Laryngospasm
  • Lidocaine
  • Local anesthesia
  • Lorazepam
  • Mallampati
  • Meperidine (Demerol)
  • Methohexital (Brevital)
  • Metoclopramide (Reglan)
  • Midazolam (Versed)
  • Moderate sedation
  • Morphine
  • Motion
  • Naloxone (Narcan)
  • Naloxone (Narcan)
  • Nil per os (NPO)
  • Nitrous oxide
  • Ondansetron (Zofran)
  • Ondansetron (Zofran)
  • Oxycodone
  • Pain
  • Pentobarbital (Nembutal)
  • Procedural sedation and analgesia (PSA)
  • Propofol
  • Psychological intervention
  • Pulmonary aspiration
  • Remifentanil
  • S-ketamine
  • Scopolamine
  • Succinylcholine
  • Sufentanil
  • Upper airway obstruction


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