M. G. Irwin

We read with great interest the recent guidelines on handling injectable medications [1]. We applaud the considerable effort the authors have made to cover a wide range of elements encompassing safe administration of anaesthesia. Mixing of injectable medications is a longstanding practice within anaesthesia but is not alluded to in this guideline.

Summary Propfol-remifentanil-based total intravenous anaesthesia has dominated recent clinical practice due to its favourable pharmacokinetic profile. Interruption in remifentanil supply has presented an opportunity to diversify or even avoid the use of opioids and consider adjuncts to propofol-based total intravenous anaesthesia. Propofol, while a potent hypnotic, is not an effective analgesic.

Surprisingly, there is no generally accepted definition for the practice of procedural sedation. Does it matter? For decades now, procedural sedation has been a thriving multidisciplinary field, spanning global practice in a variety of settings, with extensive supporting research, and numerous quality practice guidelines, statements and recommendations.