Emergency

Procedural Sedation & Analgesia

Emergency & Critical Care

Mark this drug class

Examples

fentanylmidazolamketaminepropofolmorphine

Prefix / Suffix: -azolam for benzodiazepines; -fentanil for fentanyl analogs

Physiology

Pain and anxiety increase sympathetic stress and make procedures unsafe or intolerable. Sedation and analgesia reduce pain, awareness, movement, and distress while maintaining safety.

Mechanism of Action

Opioids activate mu receptors for analgesia. Benzodiazepines enhance GABA for anxiolysis and amnesia. Ketamine provides dissociative sedation and analgesia. Propofol enhances GABA for deep sedation.

Indications

  • Procedural sedation
  • Severe acute pain
  • Post-intubation sedation
  • Cardioversion or fracture reduction
  • Trauma and emergency procedures

Side Effects / Adverse Effects

  • Respiratory depression
  • Hypotension
  • Bradycardia or tachycardia depending on agent
  • Nausea/vomiting
  • Emergence reactions with ketamine

Contraindications

  • No monitoring or airway support available
  • Severe respiratory compromise without airway plan
  • Hemodynamic instability with certain sedatives
  • Drug-specific allergy

Nursing Considerations

  • Use continuous pulse oximetry, cardiac monitoring, blood pressure, and capnography when available
  • Have oxygen, suction, bag-mask, reversal agents, and airway equipment ready
  • Assess pain and sedation level regularly
  • Do not leave sedated patients unattended
  • Document baseline assessment, doses, vital signs, and recovery status

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Disclaimer: PharmPal Nurse is for education only and is not medical advice. Do not use it to diagnose, treat, prescribe, or make patient-care decisions; always verify with current drug references, your instructor, facility policy, and a licensed provider. In emergencies, call local emergency services.