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©2013 UpToDate ® Print Email Prudent limits of targeted depth and length of ED procedural sedation and analgesia according to presedation assessment of aspiration risk * Higher-risk patients are those with one or more of the following present to a degree individually or cumulatively judged clinically important by the treating physician: potential for difficult or prolonged assisted ventilation should an airway complication occur (eg, short neck, small mandible/micrognathia, large tongue, tracheomalacia, laryngomalacia, history of difficult intubation, congenital anomalies of the airway and neck, sleep apnea). Conditions predisposing to esophageal reflux (eg, elevated intracranial pressure, esophageal disease, hiatal hernia, peptic ulcer disease, gastritis, bowel obstruction, ileus, tracheo-esophageal fistula). Extremes of age (eg, >70 years or <6 months). Severe systemic disease with definite functional limitation (ie, ASA physical status 3 or greater). Other clinical findings leading the emergency clinician to judge the patient to be at higher than standard risk (eg, altered level of consciousness, frail appearance). • Procedural urgency: emergent (eg, cardioversion for life-threatening dysrhythmia, reduction of markedly angulated fracture or dislocation with soft tissue or vascular compromise, intractable pain or suffering). Urgent (eg, care of dirty wounds and lacerations, animal and human bites, abscess incision and drainage, fracture reduction, hip reduction, lumbar puncture for suspected meningitis, arthrocentesis, neuroimaging for trauma). Semi-urgent (eg, care of clean wounds and lacerations, shoulder reduction, neuroimaging for new-onset seizure, foreign body removal, sexual assault examination). Non-urgent or elective (eg, non-vegetable foreign body in external auditory canal, chronic embedded soft tissue foreign body, ingrown toenail). Δ Procedural sedation and analgesia terminology and definitions: see "Preparation for procedural sedation in children outside of the operating room", section on 'Definitions'. Reproduced with permission from: Green, SM, Roback, MG, Miner, JG, et al. Fasting and Emergency Department Procedural Sedation and Analgesia. A Consensus-Based Clinical Proactive Advisory. Annals of Emergency Medicine 2007; 49:454. Copyright © 2007 Elsevier Science, Inc.