PMID- 30617546
OWN - NLM
STAT- MEDLINE
DCOM- 20200406
LR  - 20210109
IS  - 1438-8359 (Electronic)
IS  - 0913-8668 (Linking)
VI  - 33
IP  - 2
DP  - 2019 Apr
TI  - Procedural sedation and analgesia in the emergency department in Japan: interim 
      analysis of multicenter prospective observational study.
PG  - 238-249
LID - 10.1007/s00540-018-02606-0 [doi]
AB  - PURPOSE: Procedural sedation and analgesia (PSA) is widely performed outside of 
      the operating theater, often in emergency departments (EDs). The practice and 
      safety of PSA in the ED in an aging society such as in Japan have not been well 
      described. We aimed to characterize the practice pattern of PSA including 
      indications, pharmacology and incidence of adverse events (AEs) in Japan. 
      METHODS: We formed the Japanese Procedural Sedation and Analgesia Registry, a 
      multicenter prospective observation registry of ED patients undergoing PSA. We 
      included all patients who received PSA in the ED. PSA was defined as any systemic 
      pharmacological intervention intended to facilitate a painful or uncomfortable 
      procedure. The main variables in this study were patients' demographics, American 
      Society of Anesthesiologists (ASA) physical status, indication of PSA, medication 
      choices, and AEs. The primary outcome measure was overall AEs from PSA. RESULTS: 
      We enrolled 332 patients in four EDs during the 12-month period. The median age 
      was 67 years (IQR, 46-78). In terms of ASA physical status, 79 (23.8%), 172 
      (51.8%), and 81 (24.4%) patients were class 1, 2, 3 or higher, respectively. The 
      most common indication was cardioversion (44.0%). The most common sedative used 
      was thiopental (38.9%), followed by midazolam (34.0%) and propofol (19.6%). Among 
      all patients, 72 (21.7%, 95% confidence interval, 17-26) patients experienced one 
      or more AEs. The most common AE was hypoxia (9.9%), followed by apnea (7.2%) and 
      hypotension (3.5%). All of the AEs were transient and no patient had a serious 
      AE. CONCLUSION: In a multicenter prospective registry in Japan, PSA in the ED 
      appears safe particularly since the patients who underwent PSA were older and had 
      a higher risk profile compared to patients in previous studies in different 
      countries.
FAU - Norii, Tatsuya
AU  - Norii T
AUID- ORCID: 0000-0001-7428-5625
AD  - Department of Emergency Medicine, University of New Mexico, MSC11 6025, 1 UNM, 
      Albuquerque, NM, 87131-0001, USA. TaNorii@salud.unm.edu.
FAU - Homma, Yosuke
AU  - Homma Y
AD  - Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa 
      Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 279-0001, Japan.
FAU - Shimizu, Hiroyasu
AU  - Shimizu H
AD  - Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa 
      Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 279-0001, Japan.
FAU - Takase, Hiroshi
AU  - Takase H
AD  - Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, 880 
      Kita-Kobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, 321-0293, Japan.
FAU - Kim, Sung-Ho
AU  - Kim SH
AD  - Department of Emergency Medicine, Osaka Police Hospital, 10-31, Kitayama-cho, 
      Tennouji-ku, Osaka, 543-0035, Japan.
FAU - Nagata, Shimpei
AU  - Nagata S
AD  - Department of Emergency Medicine, Osaka Police Hospital, 10-31, Kitayama-cho, 
      Tennouji-ku, Osaka, 543-0035, Japan.
FAU - Shimosato, Akihikari
AU  - Shimosato A
AD  - Department of Anesthesiology, Kenwakai Otemachi Hospital, 15-1 Otemachi, 
      Kokurakita-ku, Kitakyushu, Japan.
FAU - Crandall, Cameron
AU  - Crandall C
AD  - Department of Emergency Medicine, University of New Mexico, MSC11 6025, 1 UNM, 
      Albuquerque, NM, 87131-0001, USA.
CN  - Japanese Procedural Sedation and Analgesia Registry investigators
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
DEP - 20190107
PL  - Japan
TA  - J Anesth
JT  - Journal of anesthesia
JID - 8905667
RN  - 0 (Hypnotics and Sedatives)
RN  - JI8Z5M7NA3 (Thiopental)
RN  - R60L0SM5BC (Midazolam)
RN  - YI7VU623SF (Propofol)
SB  - IM
MH  - Aged
MH  - Analgesia/adverse effects/*methods
MH  - Anesthesia/methods
MH  - Conscious Sedation/*methods
MH  - Electric Countershock/statistics & numerical data
MH  - *Emergency Service, Hospital
MH  - Female
MH  - Humans
MH  - Hypnotics and Sedatives/*administration & dosage
MH  - Japan
MH  - Male
MH  - Midazolam/therapeutic use
MH  - Middle Aged
MH  - Pain/drug therapy
MH  - Propofol/therapeutic use
MH  - Thiopental/administration & dosage
OTO - NOTNLM
OT  - Emergency department
OT  - Procedural sedation
OT  - Safety
FIR - Norii, Tatsuya
IR  - Norii T
FIR - Takase, Hiroshi
IR  - Takase H
FIR - Homma, Yosuke
IR  - Homma Y
FIR - Shimizu, Hiroyasu
IR  - Shimizu H
FIR - Kim, Sung-Ho
IR  - Kim SH
FIR - Nagata, Shinpei
IR  - Nagata S
FIR - Noma, Takashi
IR  - Noma T
FIR - Fukano, Kentaro
IR  - Fukano K
FIR - Shimosato, Akihikari
IR  - Shimosato A
EDAT- 2019/01/09 06:00
MHDA- 2020/04/09 06:00
CRDT- 2019/01/09 06:00
PHST- 2018/09/25 00:00 [received]
PHST- 2018/12/23 00:00 [accepted]
PHST- 2019/01/09 06:00 [pubmed]
PHST- 2020/04/09 06:00 [medline]
PHST- 2019/01/09 06:00 [entrez]
AID - 10.1007/s00540-018-02606-0 [pii]
AID - 10.1007/s00540-018-02606-0 [doi]
PST - ppublish
SO  - J Anesth. 2019 Apr;33(2):238-249. doi: 10.1007/s00540-018-02606-0. Epub 2019 Jan 
      7.