Safety and efficiency of procedural sedation and analgesia (PSA) conducted by medical officers in a level 1 hospital in Cape Town

Abstract

Objectives. To study the efficacy and safety of procedural sedation and analgesia (PSA) administered by medical officers (MOs) without formal anaesthetic training.
Methods. A retrospective descriptive study in the Emergency Department (ED) of False Bay Hospital (FBH), situated in the southern suburbs of the Cape Town Metro Health District. The study included all patients who received PSA at FBH between 1 March 2007 and 31 August 2009. Variables recorded included age, gender, physical status as determined by the American Society of Anesthesiologists (ASA status), procedure, fasting and intoxication status, PSA medications, adverse effects, rescue manoeuvres performed, if any, and time to discharge. Analysis was largely descriptive and clinical and demographic data are presented as means (standard deviations), medians, ranges and proportions as appropriate. Success of sedation and incidence of adverse effects are presented as proportions.
Results. Of 166 patients, 140 (84.3%) showed a good level of sedation, 14 (8.4%) were inadequately sedated, 5 (3%) were too deeply sedated but showed no signs of respiratory compromise, and 7 (4.2%) developed respiratory side-effects. Respiratory complications were treated with simple airway manoeuvres; no patient required intubation or experienced respiratory problems after waking up. There was no significant difference in the risk of adverse effects between the fasted and non-fasted groups. Mildly intoxicated patients who received PSA were at a higher risk of adverse effects.
Conclusion. PSA can be administered safely by medical officers. Future research should expand on PSA research in this setting and focus on safety and patient satisfaction.