A description of sedation and analgesia practices at a South African aeromedical service: a retrospective review

Colman, Stephen

A description of sedation and analgesia practices at a South African aeromedical service: a retrospective review

Author(s)

Colman, Stephen

Date Issued

2026

Type

master thesis

Publisher

Cape Peninsula University of Technology

Abstract

Background: Sedation and analgesia practices vary and are not described in the South African aeromedical setting. Rescue sedation has been identified as a sedation practice in the aeromedical setting but has not been defined in this context before. Previous literature has shown that validated sedation and analgesia monitoring tools are rarely used, and deep sedation is common. Early deep sedation in the prehospital setting could result in negative patient outcomes associated with fewer ventilator-free days, increased hospital length of stay, and mortality. Under sedation has been associated with negative patient outcomes relating to awareness during paralysis and may result in severe psychological and physical implications for affected patients. It is important to establish the proportion of patients who receive rescue sedation during transfer to determine how common this practice is. As sedation and analgesia affect patient outcomes during the early phase of patient care, a description of contemporary sedation and analgesia practices in the aeromedical setting is important. These insights may determine further research priorities in the South African aeromedical setting, which may influence guideline development and quality improvement. Aim: The aim of this research is to describe sedation and analgesia practices in the aeromedical setting and determine the proportion of patients who received rescue sedation. Methods: A descriptive cross-sectional design using retrospective chart review of patient care records (PCRs) was chosen to determine the proportion of patients in the sample who received rescue sedation and describe sedation and analgesia practices during aeromedical transfer. Inclusion and exclusion criteria were applied to sampled PCRs. A sampling technique of simple random sampling was used during the study period, and a predetermined sample size was calculated to determine the proportion of patients who received rescue sedation. Findings: This research found that the proportion of patients who received rescue sedation was 13.9% (95% CI 9.2 - 20). The most common rescue sedative administered was ketamine. In most cases, combinations of ketamine and midazolam (62.7%) were used to provide continuous sedation and analgesia during transfer. These medications were administered by syringe driver, as a continuous infusion, in 89.2% of cases. Mean doses of the ketaminemidazolam combination infusion were 2.3mg/kg/hr (SD = 0.9) of ketamine and 0.05mg/kg/hr (SD = 0.03) of midazolam. Multimodal analgesia was rarely used (13.9%). Sedation and pain assessment scores were not documented during transfer at the participating service. The adverse event rate was 32.3%, and the most common AEs were hypotension (21.5%) and hypoxia (12%). Conclusion: Rescue sedation is used occasionally at the research site. The rationale for this practice is unknown and needs to be investigated further. Recommendations have been made to include routine documentation of sedation depth and pain assessments to establish how common deep sedation is, and whether current sedation doses -as described in this research- are accomplishing adequate sedation and analgesia during transfer. Adverse events require further research to establish potential causative factors with more certainty. Sedation and analgesia practices represent modifiable risk factors affecting patient outcomes. As such, they represent areas for further research and quality improvement.

Additional information

Thesis (Master of Emergency Medical Care (MEMC))--Cape Peninsula University of Technology, 2026

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