The American College of Emergency Physicians Board of Directors approved new multidisciplinary Delphi consensus guidelines on unscheduled procedural sedation on 29 April 2026, published in two parts. Part 1 covers principles, oversight and quality monitoring. Part 2 covers clinical practice.
A word of caution about how to read this item: the published abstracts carry only the standard notice that ACEP policy documents are not peer reviewed by the journal, and contain no summary of the recommendations themselves. So this notice tells you the documents exist and what they cover, not what they say. If procedural sedation is part of your practice, they need reading in full rather than summarising second-hand — and this is the kind of document where the detail is the point.
What is worth noting is the framing. 'Unscheduled' procedural sedation is the term for sedation delivered outside a theatre list, by clinicians whose primary role is not anaesthesia, to patients who have not been fasted or optimised — which is the reality in every emergency department. Guidance written for elective anaesthesia has never fitted that situation well, and the split into an oversight-and-quality document and a clinical-practice document suggests the panel took governance as seriously as technique. That is the right emphasis: most procedural sedation incidents are system failures — monitoring not applied, rescue equipment not checked, a second clinician not present — rather than drug choices.
The transferable action while you obtain the documents is to audit your own department against those system elements. Who is credentialled to sedate, what monitoring is mandatory, who is present besides the proceduralist, what is on the rescue trolley, and how adverse events get recorded and reviewed.
- New ACEP consensus guidelines on unscheduled procedural sedation, in two parts, approved 29 April 2026.
- Part 1 covers principles, oversight and quality monitoring; Part 2 covers clinical practice.
- The published abstracts carry no summary of recommendations — read the documents themselves.
- Audit the system elements now: credentialling, mandatory monitoring, second clinician, rescue equipment.
- Most sedation incidents are system failures rather than drug-selection errors.
The statistics, in plain English
These are Delphi consensus guidelines, which means a structured process of anonymous expert rounds converging on agreed statements. That method is used where trial evidence is thin — which is the case for most procedural sedation questions, since randomising sedation regimens in unscheduled settings is difficult. Consensus reflects expert agreement, not measured effect. ACEP also states explicitly that its policy documents are not subject to the journal's peer review, which is a normal arrangement for professional-body policy but worth knowing when weighing the document.
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