Abstract
Procedural Sedation and Analgesia (PSA) is a routine practice in Emergency Departments (EDs) but few data exist in the setting of Italian ED. Thus, this study aimed to describe for the first time an Italian experience of PSA in the ED, defining usual indications, types of drug used, efficacy, and safety. We retrospectively collected consecutive adult patients undergoing PSA in the ED of the Santa Croce e Carle Hospital in Cuneo, Italy, over 6 years; we enrolled all patients who received at least one of the four drugs used for PSA (midazolam, propofol, ketamine, and fentanyl). 384 patients (62.2% male; median age 61 [42;76] years) were included in the study. Two hundred and six PSA (53.7%) were done for orthopedic maneuvers, 103 (26%) for electrical cardioversions (ECV), and 75 (19.5%) for other unpleasant medical procedures. A single drug was used in 132 cases (34.3%), while in 252 (65.7%) an association of at least two drugs was used; 239 patients (62.2%) were ASA class I, 144 (37.5%) were ASA class II and one patient was ASA class III. Three patients (0.8%) experienced PSA failure. Minor adverse events occurred during 16 procedures (4%), while no major adverse events, rescue intubation, or need for escalation of care were registered. PSA is currently used in Italian EDs and it is safe when performed by EPs for patients in ASA class I and II. An Italian prospective PSA register is to be created.