The increasingly widespread use of IV sedation and analgesia outside the operating room has garnered the attention of various organizations. The clinician's decisions regarding CS are increasingly subject to regulations and standards, and these in turn are evolving in parallel with local and national CS experience. The development of guidelines concerning ED CS has been hampered by the lack of high-quality clinical evidence, such as clinical trials, supporting particular practices. As a result, few evidence-based standards exist.
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standard specifies that a uniform standard of care must be provided throughout an accredited institution. This means that situations in which protective airway reflexes are typically expected to be lost might be held to the standard of care provided in the operating room.21 The American College of Emergency Physicians22 and the American Society of Anesthesiologists23 have also begun to promulgate guidelines. Each ED should develop standards for CS, and then strive to provide and document care consistent with that standard.
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