Emergency department sedation

Letters

CJEM 1999;1(2):92

To the editor:

Recently I forwarded the Canadian Association of Emergency Physicians' (CAEP) procedural sedation and analgesia guidelines¹ to the anesthesia department in our hospital. I felt that they would have a harder time arguing against these guidelines than our policy, and therefore that this might be a prudent first step. I was also careful to explain that we were looking for feedback (not permission).

There must have been some pent-up frustration because the letter that we received is anything but cooperative (the language notwithstanding). The premise of the letter is that we are currently providing general anesthesia in the ED and of course should not be. I disagree with the former point and agree with the latter.

There is a great deal of ignorance out there ("Why don't you just use midazolam for induction of head injuries?"), and there is always the inter-professional rivalry factor.

Our Chief of Anesthesia states that he contacted the Canadian Anaesthetists' Society (CAS), who indicated that the "CAS did not contribute to the development of the CAEP guidelines and has no comment on it." The impression I got was that CAS was involved. Could you clarify this for me?

Del Donald, MD
Sudbury, Ont.

Reference

1. Innes G, Murphy M, Nijssen-Jordan C, Ducharme J, Drummond A. Procedural sedation and analgesia in the emergency department. Canadian consensus guidelines. J Emerg Med 1999;17:145-56.