Sedation for invasive procedures is given for various clinical purposes to patients of all ages worldwide. However, sedation is a continuum to general anesthesia and contains severe inherent risks leading to mortality. Providing a simulation-based sedation training course (SEDTC) to various medical staff could be an effective strategy to improve patient and medical safety associated with sedation. The SEDTC generally includes basic airway management such as upper airway obstruction release or rapid response action toward excessive sedation, utilizing problem-based learning or simulators. However, participation alone in the SEDTC can only achieve Level 1 (reaction) or 2 (learning) in the Kirkpatrick model. A patient safety improvement of Level 3 (transfer) or 4 (result) of the Kirkpatrick model can be achieved when all members related to sedation undergo experiential learning and reach a consensus. Accordingly, in-hospital interprofessional SEDTC focusing on a resilience approach is essential to achieve effective sedation patient safety in Level 3 or 4 of the Kirkpatrick model. 

Challenges for interprofessional simulation‐based sedation training courses: Mini review

Emergency physicians (EPs) often treat anterior shoulder dislocation, but epidemiology of anterior shoulder dislocation in the emergency department of Japan remains unclear. In this study, we clarified the success rate of anterior shoulder reduction performed by EPs.

Success rate of anterior shoulder dislocation reduction by emergency physicians: a retrospective cohort study

Ultrasound-guided brachial plexus blocks are a common pain-reducing technique in the operating room and are also performed in the emergency department, primarily in adults. Performing brachial plexus blocks in the pediatric emergency department by pediatric emergency medicine physicians is yet to become common practice and may pose various challenges. Objective The aim of this study was to describe our experience with ultrasound-guided supraclavicular brachial plexus blocks performed by pediatric emergency physicians for the purpose of forearm fracture reductions in the emergency department. Methods We present a case series of 15 pediatric patients aged 7 to 17 years undergoing ultrasound-guided supraclavicular blocks. Results All blocks resulted in adequate analgesia. No procedural complications were observed. Conclusions We conclude that in select pediatric cases ultrasound-guided brachial plexus blocks can be a safe, swift, and efficient means of pain management and procedural analgesia. This approach obviates the need for sedation, thus shortening the time lag between presentation and the reduction procedure, as well as overall length of stay.

Ultrasound-Guided Supraclavicular Brachial Plexus Blocks Performed by Pediatric Emergency Medicine Physicians for Painful Orthopedic Procedures in a Pediatric Emergency Department—A Case Series

Aim The incidence and characteristics of thiopental‐related adverse events (AEs) in elderly patients during procedural sedation and analgesia (PSA) have not been well studied. We aimed to characterize thiopental‐related AE in elderly patients during PSA and compare the incidence of AE in elderly patients with non‐elderly adults. Methods This is a secondary analysis of the Japanese Procedural Sedation and Analgesia Registry (JPSTAR). We included all adult patients who received thiopental for PSA in the emergency departments and excluded patients who received concomitant sedative(s) in addition to thiopental or patients with missing body weight data. We compared the incidence of AE between the non‐elderly (18–64 years) and elderly groups (≥65 years). Results The JPSTAR had data on 379 patients who received thiopental for PSA and included 311 patients for analysis. Most (222/311, 71.3%) were elderly. Cardioversion was the most common reason for PSA (96.1%). The AE incidence between groups overall was similar, however, hypoxia was significantly more frequent in the elderly compared with the non‐elderly group (10.3% versus 2.2%; adjusted odds 5.63, 95% confidence interval 1.27–25.0). The initial and total doses of thiopental were significantly lower in the elderly group than in the non‐elderly group (1.95 mg/kg versus 2.21 mg/kg and 2.33 mg/kg versus 2.93 mg/kg, respectively). Conclusions Although elderly patients received lower doses of thiopental, hypoxic events were significantly more frequent in this group compared with the non‐elderly patients. However, the AE incidence was similar.

Incidence of adverse events for procedural sedation and analgesia for cardioversion using thiopental in elderly patients: a multicenter prospective observational study

This study aims to measure the perceived pain during the reduction of Colles fracture without anesthesia in both children and adults. It describes the process and reveals duration for reduction, total hospital stays and compares them with the same procedure under hematoma block. 

No-anesthesia for colles fracture

Procedural sedation and analgesia (PSA) is performed for a variety of indications in emergency departments (EDs). Although the practice of PSA in the ED is somewhat unique from other clinical areas, there is currently no guideline for this practice in Japan. Policy statements and guidelines for PSA have been published in Europe and North America. These guidelines suggest first evaluating patients carefully before performing PSA, and then deciding on target sedative level and choice of medications. Patient evaluation requires a combination of continuous visual observation by trained medical staff to assess the depth of sedation and respiration with noninvasive measurements of blood pressure, continuous electrocardiography monitoring, and pulse oximetry. Sedative selection should be based on its characteristics, peak time, effectiveness, and risks. It is important to administer sedatives and analgesics in small, incremental doses while keeping a close eye on the patient's reaction to avoid adverse events (AEs) until the planned sedation level is reached. Further, additional attention is needed for special populations such as pediatric and elderly patients. PSA is a key element for patient-centered care in emergency medicine. In this manuscript, we review the available evidence for PSA in the EDs, including guidelines for evaluation, monitoring, pharmacology, AEs, and special populations such as pediatric and elderly patients.

A mini‐review of procedural sedation and analgesia in the emergency department

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A mini‐review of procedural sedation and analgesia in the emergency department