Procedural Sedation Medication Selection

Provider Experience and Competence

The American Society of Anesthesiologists recommends that the selection of sedation agents depends on the experience, training, and preference of the individual practitioner 3
The American College of Emergency Physicians states that provider competence and familiarity with the chosen agent is paramount for safe sedation practice, and that the selection of sedation agents must be customized to each patient 1
The multidisciplinary consensus guideline emphasizes that sedation providers must plan the sedative regimen based on identified needs, with the understanding that provider familiarity is essential 1

Patients with moderate persistent asthma are generally excellent procedural sedation candidates, and ketamine is particularly suitable for asthma patients as it helps preserve protective airway reflexes 1
The patient's fasting status deserves assessment, but current evidence shows that non-compliance with elective fasting guidelines does not increase the risk of aspiration or other adverse events, and urgent procedures should not be delayed due to fasting status 1

Combining sedation agents (e.g., fentanyl/midazolam) increases the risk of respiratory depression, with hypoxemia occurring in 92% and apnea in 50% of volunteers 5
Ketamine can be given intramuscularly if IV access is difficult, and has a lower risk of respiratory depression compared to other agents 1

Providers should confirm immediate availability of resuscitative drugs, age-appropriate airway equipment, and personnel trained in airway management, and have specific antagonists available (naloxone, flumazenil) if using opioids or benzodiazepines 4
Never use an unfamiliar sedation agent simply because it seems theoretically ideal for the patient's condition, as complications arise from inability to manage adverse events, not from the agent itself 2