A novel prehospital pathway for procedural sedation in vulnerable patients
A new clinical pathway developed by a Physician Response Unit in London offers oral dissociative sedation using ketamine and midazolam for patients with learning disabilities who require medical procedures. This approach, designed to avoid the distress and physical restraint associated with traditional intravenous or intramuscular routes, allows carers to administer the medication in a drink under medical supervision. In its first year, the pathway was used for 9 out of 36 referred patients, with no serious adverse events reported, successfully enabling previously impossible investigations and interventions.
Why it might matter to you: For rheumatologists managing complex inflammatory arthritis or autoimmune diseases, procedural sedation is sometimes necessary for joint injections, imaging, or biopsies in patients with cognitive or behavioral challenges. This model demonstrates a practical, patient-centered alternative to standard sedation protocols that could be adapted for rheumatology practice. It highlights the importance of developing tailored procedural pathways to improve healthcare access and reduce distress for vulnerable populations with chronic conditions.
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