Adverse Events Rate in Adults Having Procedural Sedation in the Emergency Department: A Systematic Review and Meta-analysis

Author(s):

Ethar Hussain Alqassab, Alhanouf Ibrahim Alzanitan, Saleh Bin Ali Alghamdi, Futoon Jomman Alomari, Sara Nabeel Mermulla, Hamidah Abdullah Almusaylim, Muath Adnan Alismail, Hamad Ali Alyami, Rehab Ismail Mohammed, Umkalthom Mahmoud Kissnawi and Rawa Khaled Alhelaili

Background: The use of numerous analgesics, sedative, and anesthetic agents has been outlined in numerous guidelines. Several classes and combinations of medication are commonly used for procedural sedation in the emergency department (ED). Aim: This work aims to determine the rate of adverse events for adult patients having procedural sedation in the emergency department. Materials and Methods: A systematic search was performed over different medical databases to identify Emergency Medicine studies, which studied the incidence of adverse events in adult patients having emergency procedural sedation. Using the meta-analysis process, either with fixed or random-effects models, we conducted a meta-analysis on overall complications rate as a primary outcome, and incidence of (agitation, aspiration, bradycardia, hypotension, hypoxia, and the need for intubation), as secondary outcomes. Results: Twenty-four studies were identified involving 2348 patients. The meta-analysis process revealed that the estimated pooled prevalence of adverse events among adult patients having emergency procedural sedation was (6.61%). The estimated pooled prevalence of each adverse event were (1.92%), (0.18%), (0.97%), (1.71%), (3%), and (2.18%), respectively. Conclusion: To conclude, procedural sedation and analgesia (PSA) are routinely performed in the emergency department (ED) to facilitate potentially painful procedures by alleviating pain, anxiety, and suffering serious adverse events during procedural sedation laryngospasm, aspiration, and intubation are exceedingly rare.