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Efficacy, safety and patient satisfaction of propofol for procedural sedation and analgesia in the emergency department: a prospective study

Published online by Cambridge University Press:  21 May 2015

Peter J. Zed ,
Riyad B. Abu-Laban ,
Winnie W.Y. Chan  and
David W. Harrison
Peter J. Zed*
Affiliation:
Department of Pharmacy and Pharmacotherapuetic Specialist–Emergency Medicine, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS College of Pharmacy and Department of Emergency Medicine, Dalhousie University, Halifax, NS Pharmacotherapeutic Specialist–Emergency Medicine, CSU Pharmaceutical Sciences, Vancouver General Hospital (VGH), University of British Columbia (UBC), Vancouver, BC Faculty of Pharmaceutical Sciences and Associate Member, Division of Emergency Medicine, University of British Columbia (UBC), Vancouver, BC
Riyad B. Abu-Laban
Affiliation:
Department of Emergency Medicine, VGH, UBC, Vancouver, BC Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, UBC, Vancouver, BC Michael Smith Foundation for Health Research, UBC, Vancouver, BC Division of Emergency Medicine, UBC, Vancouver, BC
Winnie W.Y. Chan
Affiliation:
CSU Pharmaceutical Sciences, VGH, Vancouver, BC
David W. Harrison
Affiliation:
Department of Emergency Medicine and Director, Hyperbaric Unit, VGH, UBC, Vancouver, BC Division of Emergency Medicine, UBC, Vancouver, BC
*
Queen Elizabeth II Health Sciences Centre, Department of Pharmacy – Halifax Infirmary, Rm. 2417, 1796 Summer St., Halifax NS B3H 3A7; [email protected]

Abstract

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Objective:

We evaluated the efficacy, safety and patient satisfaction with the use of propofol for procedural sedation and analgesia in the emergency department (ED).

Methods:

All patients receiving propofol for procedural sedation and analgesia in the ED between December 1, 2003, and November 30, 2005, were prospectively assessed. Propofol was administered using a standardized protocol, which included an initial dose of 0.25–0.5 mg/kg followed by 10–20 mg/minute until sedated. Efficacy was evaluated using procedural success rate, recovery time and physician satisfaction. Adverse respiratory effects were defined as apnea for more than 30 seconds or an oxygen saturation of less than 90%. Hypotension was defined as systolic blood pressure < 90 mm Hg or > 20% decrease from baseline. Patient and physician satisfaction were determined using 5-point Likert scales.

Results:

Our study included 113 patients with a mean age of 50 (standard deviation [SD] 19) years; 62% were male. The most common procedures were orthopedic manipulation (44%), cardioversion (37%), and abscess incision and drainage (13%). The mean total propofol dose required was 1.6 (SD 0.9) mg/kg. Procedural success was achieved in 90% of cases and the mean patient recovery time was 7.6 (SD 3.4) minutes. No patient (0%, 95% confidence interval [CI] 0%–3%) experienced apnea; however, 1 patient (1%, 95% CI 0%–5%) experienced emesis, which resulted in an oxygen saturation <90%. Nine patients (8%, 95% CI 4%–15%) experienced hypotension and 7 (6%, 95% CI 3%–12%) experienced pain on injection. All patients were very satisfied (92%, 95% CI 85%–96%) or satisfied (8%, 95% CI 4%–15%), and 94% (95% CI 88%–98%) reported no recollection of the procedure. The majority of physicians were very satisfied (85%, 95% CI 77%–91%) or satisfied (6%, 95% CI 3%–12%) with the sedation and the conditions achieved.

Conclusion:

When administered as part of a standardized protocol, propofol appears to be a safe and effective agent for performing procedural sedation and analgesia in the ED, and is associated with high patient and physician satisfaction.

Keywords

propofolprocedural sedationanalgesiaemergency department
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 9 , Issue 6 , November 2007 , pp. 421 - 427
Copyright
Copyright © Canadian Association of Emergency Physicians 2007

References

1.Bahn, EL, Holt, KR. Procedural sedation and analgesia: a review and new concepts. Emerg Med Clin North Am 2005;23:503–17.CrossRefGoogle ScholarPubMed
2.AmericanCollege of Emergency Physicians Clinical Policies Subcommittee on Procedural Sedation and Analgesia. Procedural sedation and analgesia in the emergency department. Ann Emerg Med 2005;45:177–96.CrossRefGoogle Scholar
3.Innes, G, Murphy, M, Nijssen-Jorden, C, et al. Procedural sedation and analgesia in the emergency department. Canadian consensus guidelines. J Emerg Med 1999;17:145–56.CrossRefGoogle ScholarPubMed
4.American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002;96:1004–17.CrossRefGoogle Scholar
5.Schneider, MS, Coates, WC. Use of ultrashort-acting hypnotic agents in emergency departments. West J Med 1996;164:64–5.Google ScholarPubMed
6.Grafstein, E, Innes, G, Roland, K. Do injection drug users have different medication requirements in procedural sedation? [abstract]. Can J Emerg Med 2000;2:180.Google Scholar
7.Innes, G, Grafstein, E, Christenson, JM, et al. Ketamine vs. fentanyl/midazolam for procedural sedation in intravenous drug users. [abstract]. Can J Emerg Med 2000;2:185.Google Scholar
8.Wright, SW, Chudnofsky, CR, Dronen, SC, et al. Midazolam use in the ED. Am J Emerg Med 1990;8:97–100.CrossRefGoogle Scholar
9.Ramoska, EA, Linkenheimer, R. Glascow, C. Midazolam use in the ED. J Emerg Med 1991;9:247–51.CrossRefGoogle Scholar
10.Chudnofsky, CR, Wright, SW, Dronen, SC, et al. The safety of fentanyl use in the ED. Ann Emerg Med 1989;18:635–9.CrossRefGoogle Scholar
11.Epstein, FB. Ketamine dissociative sedation in pediatric emergency medical practice. Am J Emerg Med 1993;11:180–2.CrossRefGoogle ScholarPubMed
12.Chudnofsky, CR, Weber, JE, Stoyanoff, PJ, et al. A combination of midazolam and ketamine for procedural sedation and analgesia in adult emergency department patients. Acad Emerg Med 2000;7:228–35.CrossRefGoogle ScholarPubMed
13.Falk, J, Zed, PJ. Etomidate for procedural sedation in the emergency department. Ann Pharmacother 2004;38:1272–7.Google Scholar
14.Miller, MA, Levy, P, Patel, MM. Procedural sedation and analgesia in the emergency department: what are the risks? Emerg Med Clin North Am 2005;23:551–72.CrossRefGoogle ScholarPubMed
15.Bailey, PL, Pace, NL, Ashburn, MA, et al. Frequent hypoxemia and apnea after sedation with midazolam and fentanyl. Anesthesiology 1990;73:826–30.Google Scholar
16.Bryson, HM, Fulton, BR, Faulds, D. Propofol: an update of its use in anaesthesia and conscious sedation. Drugs 1995;50:513–59.CrossRefGoogle ScholarPubMed
17.Swanson, ER, Seaberg, DC, Stypula, RW, et al. Propofol for conscious sedation: a case series. Acad Emerg Med 1995;2:661–3.Google Scholar
18.Swanson, ER. Seaberg, DC, Mathias, S. The use of propofol for sedation in the emergency department. Acad Emerg Med 1996;3:234–8.CrossRefGoogle ScholarPubMed
19.Havel, CJ, Strait, RT, Hennes, H. A clinical trial of propofol versus midazolam for procedural sedation in a pediatric emergency department. Acad Emerg Med 1999;6:989–97.CrossRefGoogle Scholar
20.Skokan, EG, Pribble, C, Bassett, KE. Use of propofol in a pedi-atric emergency department: a prospective study. Clin Pediatr (Phila) 2001;40:663–71.Google Scholar
21.Bassett , KE, Anderson, JL, Pribble, CG, et al. Propofol for procedural sedation in children in the emergency department. Ann Emerg Med 2003;42:773–82.Google Scholar
22.Guenther, E, Pribble, CG, Junkins, EP Jr, et al. Propofol sedation by emergency physicians for elective pediatric outpatient procedures. Ann Emerg Med 2003;42:783–91.CrossRefGoogle ScholarPubMed
23.Godambe, SA, Elliot, V, Matheny, D, et al. Comparison of propo-fol/fentanyl versus ketamine/midazolam for brief orthopedic procedural sedation in a pediatric emergency department. Pediatrics 2003;112:116–23.Google Scholar
24.Coll-Vinent, B, Sala, X, Fernandez, C. Sedation for cardioversion in the emergency department: analysis of effectiveness of four protocols. Ann Emerg Med 2003;42:767–72.Google Scholar
25.Miner, JR, Biros, M, Kreig, S, et al. Randomized clinical trial of propofol versus methohexital for procedural sedation during fracture and dislocation reduction in the emergency department. Acad Emerg Med 2003;10:931–7.Google Scholar
26.Pershad, J, Godambe, SA. Propofol for procedural sedation in the pediatricemergency department. J Emerg Med 2004;27:11–4.CrossRefGoogle Scholar
27.Frazee, BW, Park, RS, Lowery, D, et al. Propofol for deep procedural sedation in the ED. Am J Emerg Med 2005;23:190–5.Google Scholar
28.Miner, JR, Martel, ML, Meyer, M, et al. Procedural sedation of critically-ill patients in the emergency department. Acad Emerg Med 2005;12:124–8.CrossRefGoogle ScholarPubMed
29.Taylor, DM, O’Brien, D, Ritchie, P, et al. Propofol versus midazolam/fentanyl for reduction of anterior shoulder dislocation. Acad Emerg Med 2005;12:13–9.CrossRefGoogle ScholarPubMed
30.Burton, JH, Miner, JR, Shipley, ER, et al. Propofol for emergency department procedural sedation and analgesia: a tale of three centers. Acad Emerg Med 2006;13:24–30.CrossRefGoogle ScholarPubMed
31.Valtonen, M, Kanto, J, Klossner, J. Anaesthesia for cardioversion: a comparison of propofol and thiopentone. Can J Anaesth 1988;35:479–83.Google Scholar
32.Gupta, A, Lennmarken, C, Vegfors, M, et al. Anesthesia for cardioversion. A comparison between propofol, thiopenton, and midazolam. Anaesthesia 1990;45:872–5.CrossRefGoogle Scholar
33.Canessa, R, Guillermo, L, Urzua, J, et al. Anesthesia for elective cardioversion: a comparison of four anesthetic agents. J Cardiothorac Vasc Anesth 1991;5:.566–8.Google Scholar
34.Sternlo, JE, Hagerdal, M. Anaesthesia for cardioversion — clinical experience with propofol and thiopentone. Acta Anaesthesiol Scand 1991;35:606–8.Google Scholar
35.Hullander, RM, Leivers, D, Wingler, K. A comparison of propofol and etomidate for cardioversion. Anesth Analg 1993;77:690–4.CrossRefGoogle ScholarPubMed
36.Gale, DW, Usaf, M, Grissom, TE, et al. Titration of intravenous anesthetics for cardioversion: a comparison of propofol, metho-hexital, and midazolam. Crit Care Med 1993;21:1509–13.Google Scholar
37.Hug, CC Jr, McLeskey, CH, Nahrwold, ML, et al. Hemodynamic effects of propofol: data from over 25,000 patients. Anesth Analg 1993;77(Suppl):S21-9.Google ScholarPubMed
38.Picard, P, Tramer, MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anesth Analg 2000;90:963–9.Google ScholarPubMed
39.Johnson, RA, Harper, NJN, Chadwick, S, et al. Pain on injection of propofol. Methods of alleviation. Anaesthesia 1990;45:439–42.CrossRefGoogle ScholarPubMed
40.Green, SM. Propofol for emergency department procedural sedation — not yet ready for prime time. Acad Emerg Med 1999;6:975–8.CrossRefGoogle Scholar
41.Innes, G. Emergency department sedation guidelines: a tale of two specialties [editorial]. Can J Emerg Med 1999;1:88.Google Scholar
42.Wilbur, K, Zed, PJ. Is propofol an optimal agent for procedural sedation and rapid sequence intubation in the emergency department? Can J Emerg Med 2001;3:302–10.Google Scholar
43.Green, SM, Krauss, B. Propofol in emergency medicine: pushing the sedationfrontier. Ann Emerg Med 2003;42:792–7.Google Scholar
44.Ramsay, MA, Savege, TM, Simpson, BR, et al. Controlled sedation with alphaxalone-alphadolone. BMJ 1974;2:656–9.CrossRefGoogle ScholarPubMed
45.Campbell, SG, Magee, KD, Kovacs, GJ, et al. Procedural sedation and analgesia in a Canadian adult tertiary care emergency department: a case series. Can J Emerg Med 2006;8:85–93.CrossRefGoogle Scholar
46.Mensour, M, Pineau, R, Sahai, V, et al. Emergency department procedural sedation and analgesia: a Canadian Community Effectiveness and Safety Study (ACCESS). Can J Emerg Med 2006;8:94–9.CrossRefGoogle ScholarPubMed
47.Miner, JR, Krauss, B. Procedural sedation and analgesia research: state ofthe art. Acad Emerg Med 2007;14:170–8.Google Scholar