Comparison of midazolam and diazepam for conscious sedation in the emergency department

Wright, Seth W.; Chudnofsky, Carl R.; Dronen, Steven C.; Kothari, Rashmikant; Birrer, Patrick; Blanton, Donald; Bruner, Alexandra

doi:10.1016/s0196-0644(05)80203-3

Cited by 52 publications

(24 citation statements)

References 12 publications

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“…6,[10][11][12] We found 9 additional RCTs that did not report direct comparisons between the study drugs, but in which either midazolam or propofol had been studied and could be included in the analysis of AEs. 2,5,21,22,[29][30][31][32][33][34] An additional 15 observational studies met inclusion criteria for the analysis of AEs. 1,15,20,23,24,33,[35][36][37][38][39][40][41][42][43] Study Characteristics Studies included in the analysis of AEs enrolled between 4 and 860 patients (see supplementary Table S1).…”

Section: Trial Flowmentioning

confidence: 99%

Safety and Clinical Effectiveness of Midazolam versus Propofol for Procedural Sedation in the Emergency Department: A Systematic Review

Hohl

Sadatsafavi²,

Nosyk³

et al. 2008

Academic Emergency Medicine

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Objectives: To synthesize the evidence comparing the adverse event (AE) profile and clinical effectiveness of midazolam and propofol for procedural sedation (PS) in adults in the emergency care setting. Methods:The authors conducted a systematic review of randomized controlled trials (RCTs) and observational studies reporting the use of either midazolam and ⁄ or propofol for adult PS in the emergency department (ED). A systematic search strategy was developed and applied to six bibliographic reference databases. Three emergency medicine journals, the Canadian Adverse Drug Reaction Newsletter, and conference proceedings were hand-searched. Retrieved articles were reviewed and data were abstracted using standardized data collection. Trial quality was assessed using the Jadad score. The outcomes assessed were the proportion of patients with AEs and the pooled mean difference in the proportion of patients with successful PS.Results: Of 229 articles identified, 28 met the inclusion criteria for the analysis of AEs. Only one major AE to PS was found, resulting in no statistically significant difference in the proportion of major AEs between agents. Four studies were RCTs that met the inclusion criteria for the analysis of clinical effectiveness. Two trials met criteria for good quality. The RCTs enrolled between 32 and 86 patients, and the most common indications for PS were orthopedic reductions and cardioversions. There was a nonsignificant difference in the proportion of patients with successful PS in favor of propofol (effect difference 2.9%, 95% confidence interval (CI) = -6.5 to 15.2). Conclusions:The authors found no significant difference in the safety profile and the proportion of successful PS between midazolam and propofol for adults in the ED.ACADEMIC EMERGENCY MEDICINE 2008; 15:1-8 ª

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Section: Trial Flowmentioning

confidence: 99%

Safety and Clinical Effectiveness of Midazolam versus Propofol for Procedural Sedation in the Emergency Department: A Systematic Review

Hohl

Sadatsafavi²,

Nosyk³

et al. 2008

Academic Emergency Medicine

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“…[1][2][3][4][5][6] These rates are high compared to the 0.1-0.2% incidence of awareness after general anaesthesia. 7 In none of the ED studies was recall the primary outcome measure.…”

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confidence: 93%

Recall after procedural sedation in the emergency department

Swann

Williams

Fatovich

2007

Emergency Medicine Journal

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Background: Procedural sedation (PS) is common in the emergency department (ED) and ideally patients should have no recall of the procedure. Aim: To determine the incidence of recall. Methods: A prospective observational study in an university ED of all patients undergoing PS. Data were collected on a pre-formatted data sheet. Levels of satisfaction with the sedation by the treating physician and nurse were recorded on a 10 cm visual analogue scale. On recovery, the patient was asked a validated questionnaire to determine the rate of immediate recall and at telephone follow-up for delayed recall. Results: 125 patients (88 male, 70%) were enrolled and 110 had completed follow-up. Mean (range) age was 51.6 (13-91) years. Procedures included 84 (67%) orthopaedic reductions and 41 (33%) cardioversions. A wide range of drug combinations were used, including fentanyl/propofol 32 (25.6%), fentanyl/midazolam 30 (24%), fentanyl/midazolam/propofol 16 (12.8%), propofol 13 (10.4%). 87.2% of procedures were successful. A grimace/groan was observed in 61 of 125 (49%). Immediate recall occurred in 9 of 121 (7.4%; 95% CI 3.7 to 14.0) and delayed recall in 5 of 110 (4.5%; 95% CI 1.7 to 10.8). No drug combination was correlated with recall (Spearman's rho = 0.149), nor the presence of a grimace/groan (r = 20.039). Median sedation satisfaction scores were physician 9.0, nurse 10, patient 10. Correlation of delayed recall with patient satisfaction was -0.471 (p,0.001). Conclusions: Recall following PS in ED is uncommon. There is no association of recall with drugs used or the presence of a grimace/groan. There is high patient satisfaction with PS in the ED.

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“…[3][4][5][6][7][8][9][10] Unfortunately, all of these agents may cause respiratory depression, particularly when given in combination, in large doses, or to patients with underlying respiratory diseases. 3,[5][6][7][8][9][10][11][12][13][14] Ketamine hydrochloride is a phencyclidine derivative that causes dissociation between the cortical and limbic systems, preventing the higher centers from perceiving visual, auditory, or painful stimuli. It possesses a rapid onset and short duration of action and produces profound sedation and analgesia.…”

mentioning

confidence: 99%

A Combination of Midazolam and Ketamine for Procedural Sedation and Analgesia in Adult Emergency Department Patients

Chudnofsky

Weber

Stoyanoff

et al. 2000

Academic Emergency Medicine

123

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Abstract. Objective:To describe the clinical characteristics of a combination of midazolam and ketamine for procedural sedation and analgesia in adult emergency department (ED) patients. Methods: This was a prospective, observational trial, conducted in the ED of an urban level II trauma center. Patients Ն 18 years of age requiring procedural sedation and analgesia were eligible, and enrolled patients received 0.07 mg/kg of intravenous midazolam followed by 2 mg/kg of intravenous ketamine. Vital signs were recorded at regular intervals. The adequacy of sedation, adverse effects, patient satisfaction, and time to reach discharge alertness were determined. Descriptive statistics were calculated using statistical analysis software. Results: Seventy-seven patients were enrolled. Three were excluded due to protocol violations, three due to lack of documentation, and one due to subcutaneous infiltration of ketamine, leaving 70 patients for analysis. The average age was 31 years, and 41 (59%) were female. Indications for procedural sedation and analgesia included abscess incision and drainage (66%), fracture/joint reduction (26%), and other (8%). The mean dose of midazolam was 5.6 Ϯ 1.4 mg and the mean dose of ketamine was 159 Ϯ 42 mg. The mean time to achieve discharge criteria was 64 Ϯ 24 minutes. Five patients experienced mild emergence reactions, but there were no episodes of hallucinations, delirium, or other serious emergence reactions. Eighteen (25%) patients recalled dreaming while sedated; twelve (17%) were described as pleasant, two (3%) unpleasant, three (4%) both pleasant and unpleasant, and one (1%) neither pleasant nor unpleasant. There were four (6%) cases of respiratory compromise, two (3%) episodes of emesis, and one (1%) case of myoclonia. All of these were transient and did not result in a change in the patient's disposition. Only one (1%) patient indicated that she was not satisfied with the sedation regimen. Conclusions: The combination of midazolam and ketamine provides effective procedural sedation and analgesia in adult ED patients, and appears to be safe.

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Comparison of midazolam and diazepam for conscious sedation in the emergency department

Cited by 52 publications

References 12 publications

Safety and Clinical Effectiveness of Midazolam versus Propofol for Procedural Sedation in the Emergency Department: A Systematic Review

Safety and Clinical Effectiveness of Midazolam versus Propofol for Procedural Sedation in the Emergency Department: A Systematic Review

Recall after procedural sedation in the emergency department

A Combination of Midazolam and Ketamine for Procedural Sedation and Analgesia in Adult Emergency Department Patients

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