Emergency Department Clinical Pathway
for Procedural Sedation
  • Indications for Admission
  • Sedation related:
    • Less than 28 days (FT)
    • Less than 60 weeks post-conceptual age
    • Need for further monitoring
  • Other medical/surgical reason for admission
Anesthesia Consult
Call Board Runner at 54444 or Attending Anesthesiologist on call
ED Team to discuss with Anesthesia to determine sedation plan and appropriateness for ED sedation for the following patient scenarios
  • ASA 4/5
  • Age less than 6 months for moderate sedation, less than 1 year for deep sedation
  • Known or suspected difficult airway based on exam or syndrome, history of or active airway obstruction (severe OSA, active croup)
  • Clinical concern for increased intracranial pressure with urgent procedure
  • Length of procedure > 30-45 min or need for motionless anesthesia
Consider Anesthesia Consult
Call Board Runner at 54444 or Attending Anesthesiologist on call
ED team to assess patient and consider Anesthesia consult for the following scenarios
  • Chronic lung disease
  • ASA 3
  • C-collar in place
  • Impending OR for other procedure
  • Status epilepticus or poorly controlled seizure disorder
  • Acute asthma exacerbation requiring frequent bronchodilators
  • Autism/behavioral issues
  • Resource requirement
    • Complexity of procedure, pain, amount of sedation medication required
  • Ongoing emesis; impaired GI motility syndromes
Cardiology Consult
  • Generally safe for ED sedation
    • Repaired isolated PDA, ASD, VSD, coarctation with no hemodynamic or electrophysiologic compromise
  • Generally not appropriate for ED sedation
    • Pulmonary Hypertension
    • Heart failure
    • Cardiomyopathy
    • Single ventricle physiology
    • Dysrhythmia
  • For all other cardiac patients requiring procedural sedation, consult Cardiology for assistance on determination of appropriateness for ED sedation. Cardiac Anesthesia can be consulted for additional guidance.
Posted: July 2020
Revised: August 2020, September 2020
Authors: J. Del Pizzo, MD; J. Fein, MD, MPH; K. Crescenzo, RN; S. Jarrett, MD; F. McGowan, MD; B. Blowey PharmD; H. Huang, PharmD