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Factors associated with failure to successfully complete a procedure during emergency department sedation


  • Anna Holdgate, MMed, FACEM, Director of Emergency Medicine Research; David McD Taylor, MD, MPH, DRCOG, FACEM, Director of Emergency and General Medicine Research, Principal Fellow; Anthony Bell, FACEM, Director of Emergency Medicine; Catherine MacBean, BA, DipEd, Research Assistant (formerly); Truc Huynh, FACEM, Staff Specialist; Ogilvie Thom, FACEM, Staff Specialist; Michael Augello, FACEM, Staff Specialist, Honorary Fellow; Robert Millar, FACEM, Staff Specialist; Robert Day, FACEM, Staff Specialist; Aled Williams, FACEM, Staff Specialist; Peter Ritchie, FACEM, Director of Emergency Medicine; John Pasco, FACEM, Director of Emergency Medicine.

A/Prof David McD Taylor, Emergency Department, Austin Health, Studley Road, Heidelberg, Vic. 3084, Australia. Email:


Objective: To determine factors associated with failure to successfully complete a procedure during sedation in the ED.

Methods: Eleven Australian EDs enrolled consecutive adult and paediatric patients between January 2006 and December 2008. Patients were included if a sedative drug was administered for an ED procedure and the success or failure of the procedure was recorded.

Results: Data were available for 2567 patients. Of these, 1548 (60.3%, 95% CI 58.4–62.2) were male and 456 (17.8%, 95% CI 16.3–19.3) were age <16 years. The most common procedures performed were reduction of major joints and laceration repair. A total of 149 procedures (5.8%, 95% CI 5.0–6.8) failed. There were significant differences in failure rates between the types of procedure undertaken, with reduction of hips, digits and mandibles associated with the highest failure rates (P < 0.001). In adults, body weight >100 kg was also associated with increased risk of procedural failure (odds ratio 2.3, 95% CI 1.3–4.1). Ketamine used as a single agent had the lowest procedural failure rate (2.5%, 95% CI 1.1–5.4) whereas propofol had the highest (5.9%, 95% CI 4.6–7.6). However, these two drugs were generally used in different age groups and for different procedures.

Conclusions: Procedures performed under sedation in the ED have a low failure rate. However, increased body weight and specific procedures, such as hip reduction, are associated with significantly higher failure rates. Special consideration should be given to these patient groups before undertaking sedation in the ED.