Your teenager, quite confident that he is immune to any injury, tries an airborne 360 at the skateboard. He makes it about 180, lands and then falls on his outstretched wrist. He then arrives home, with an obviously deformed wrist. You take him to the local emergency room where the doctor on call informs you that, yes he has broken his wrist (no great surprise here) and that the wrist can indeed be reduced. The catch is that something called “procedural sedation” has to be used in order to reduce the wrist without your son experiencing severe pain.
Just what is procedural sedation? This is a method of sedating or putting a patient in a semiconscious state so that painful and or invasive procedures can be performed. Procedural sedation is not general anesthesia: The airway and breathing remain intact; it is best used for emergency department procedures such as reducing fractures, suturing (in small children) or placing iv lines in large veins. Done properly, the patient sleeps through the procedure and doesn’t remember anything about what happened.
There are risks involved. If the patient receives too much sedation, she might stop breathing and emergency airway would then need to be placed. The blood pressure might drop. The airway protective reflexes are hindered and rarely a patient might aspirate or vomit up stomach contents into the airway. There is always the potential of allergic reactions to the medications used. Occasionally, the medications might not be strong enough and the patient would then need more.
Ideally, the procedure should be performed after several hours of fasting-but in an emergency can be done with as little as 2 or 3 hours of fasting, depending on for example whether the last meal was a small yogurt or a triple cheeseburger with fries and whether or not the patient has serious underlying illnesses.
Procedural sedation should be only performed in hospitals or ambulatory care centers, where specially trained physicians, nurses and respiratory therapists are at the bedside. It should not be done in a doctor’s office, where such specialists are almost always not around.
Overall, procedural sedation when guidelines are followed is a very safe way of assisting patients who are undergoing painful interventions. And guess what? A few months after your son has his wrist reduced, he can go out yet again to that skateboard park!