Journal of Anesthesia

, Volume 33, Issue 2, pp 238–249 | Cite as

Procedural sedation and analgesia in the emergency department in Japan: interim analysis of multicenter prospective observational study

  • Tatsuya NoriiEmail author
  • Yosuke Homma
  • Hiroyasu Shimizu
  • Hiroshi Takase
  • Sung-Ho Kim
  • Shimpei Nagata
  • Akihikari Shimosato
  • Cameron Crandall
  • On behalf of the Japanese Procedural Sedation and Analgesia Registry investigators
Original Article



Procedural sedation and analgesia (PSA) is widely performed outside of the operating theater, often in emergency departments (EDs). The practice and safety of PSA in the ED in an aging society such as in Japan have not been well described. We aimed to characterize the practice pattern of PSA including indications, pharmacology and incidence of adverse events (AEs) in Japan.


We formed the Japanese Procedural Sedation and Analgesia Registry, a multicenter prospective observation registry of ED patients undergoing PSA. We included all patients who received PSA in the ED. PSA was defined as any systemic pharmacological intervention intended to facilitate a painful or uncomfortable procedure. The main variables in this study were patients’ demographics, American Society of Anesthesiologists (ASA) physical status, indication of PSA, medication choices, and AEs. The primary outcome measure was overall AEs from PSA.


We enrolled 332 patients in four EDs during the 12-month period. The median age was 67 years (IQR, 46–78). In terms of ASA physical status, 79 (23.8%), 172 (51.8%), and 81 (24.4%) patients were class 1, 2, 3 or higher, respectively. The most common indication was cardioversion (44.0%). The most common sedative used was thiopental (38.9%), followed by midazolam (34.0%) and propofol (19.6%). Among all patients, 72 (21.7%, 95% confidence interval, 17–26) patients experienced one or more AEs. The most common AE was hypoxia (9.9%), followed by apnea (7.2%) and hypotension (3.5%). All of the AEs were transient and no patient had a serious AE.


In a multicenter prospective registry in Japan, PSA in the ED appears safe particularly since the patients who underwent PSA were older and had a higher risk profile compared to patients in previous studies in different countries.


Procedural sedation Safety Emergency department 



The authors thank the following study hospitals and research personnel for their assistance with this project: Sendai City Hospital (Yuji Murata, MD, PhD), Tokyo Bay Urayasu Ichikawa Medical Center (Hikaru Funakoshi, MD, MPH, PhD), Osaka Police Hospital (Yasuaki Mizushima, MD, PhD, Takashi Noma, MD), Kenwakai Otemachi Hospital (Yasuyuki Yamamoto, MD) and all personnel at participating hospitals who contributed the data. We also wound like to acknowledge Danielle Albright, PhD, and Darren Braude, MD, for their valuable comments and suggestions in improving the quality of this study. Japanese Procedural Sedation and Analgesia Registry investigators: Tatsuya Norii, Hiroshi Takase, Yosuke Homma, Hiroyasu Shimizu, Sung-Ho Kim, Shimpei Nagata, Takashi Noma, Kentaro Fukano, Akihikari Shimosato

Compliance with ethical standards

Conflict of interest

All authors deny any conflict of interest.


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Copyright information

© Japanese Society of Anesthesiologists 2019

Authors and Affiliations

  • Tatsuya Norii
    • 1
    Email author
  • Yosuke Homma
    • 2
  • Hiroyasu Shimizu
    • 2
  • Hiroshi Takase
    • 3
  • Sung-Ho Kim
    • 4
  • Shimpei Nagata
    • 4
  • Akihikari Shimosato
    • 5
  • Cameron Crandall
    • 1
  • On behalf of the Japanese Procedural Sedation and Analgesia Registry investigators
  1. 1.Department of Emergency MedicineUniversity of New MexicoAlbuquerqueUSA
  2. 2.Department of Emergency and Critical Care MedicineTokyo Bay Urayasu Ichikawa Medical CenterUrayasuJapan
  3. 3.Department of Diagnostic and Generalist MedicineDokkyo Medical UniversityTochigiJapan
  4. 4.Department of Emergency MedicineOsaka Police HospitalOsakaJapan
  5. 5.Department of AnesthesiologyKenwakai Otemachi HospitalKitakyushuJapan

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