Pain management/case report
Aspiration Pneumonitis Requiring Intubation After Procedural Sedation and Analgesia: A Case Report

https://doi.org/10.1016/j.annemergmed.2006.09.004Get rights and content

Emergency department (ED) procedural sedation and analgesia is widely and routinely performed; serious complications are rare. We describe the first reported case of aspiration during procedural sedation in the ED. Although our patient required endotracheal intubation and critical care admission, there was no adverse long-term outcome. Given that there were no apparent predisposing factors, we believe it is crucial for emergency physicians to routinely anticipate the possibility of such a complication during each sedation event.

Introduction

Procedural sedation and analgesia involves the use of sedatives, analgesics, and dissociative agents to facilitate short and often painful procedures. At our tertiary care institution, procedural sedation and analgesia in the emergency department (ED) is performed frequently (approximately 80 times per month). Adverse events, including hypoxemia and hypotension, are rare.1 We present the first reported case of aspiration pneumonitis requiring intubation as a result of procedural sedation and analgesia in the ED.

Section snippets

Case Report

A 65-year-old woman presented to the ED with left ankle pain after slipping while trying to get into her car. She had a deformed left ankle, with a normal neurovascular examination result. She was alert and oriented and had no other injuries. Her vital signs were blood pressure 157/77 mm Hg, pulse rate 85 beats/min, respiratory rate 14 breaths/min, and SaO2 96% on room air. She weighed approximately 75 kg. There was a smell of ethanol, but the patient was fully coherent and able to give an

Discussion

Procedural sedation and analgesia has become standard of care in EDs and is associated with few significant complications.2, 3, 4, 5 Before this case report, there had been no published case of aspiration related to ED procedural sedation and analgesia.6 From the anesthesia literature, specific factors known to increase the risk of aspiration in the operating room include conditions predisposing to gastroesophageal reflux, a higher American Society of Anesthesiologists physical status

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Supervising editor: Steven M. Green, MD

Funding and support: The authors report this study did not receive any outside funding or support.

Reprints not available from the authors.

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