Emergency department sedation guidelines: a tale of two specialties

Innes, Grant

doi:10.1017/s1481803500003687

Cited by 7 publications

(5 citation statements)

References 10 publications

(6 reference statements)

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“…[31][32][33][34][35][36][37] The use of propofol for procedural sedation and analgesia in the ED is controversial. [40][41][42][43] Proponents argue that with proper titration and monitoring propofol facilitates safe and effective procedural sedation and analgesia when administered by a trained emergency physician. Critics point to a scarcity of evidence in the ED setting.…”

Section: Discussionmentioning

confidence: 99%

“…[37][38][39] Despite widespread use in the ED, there has been controversy regarding the use of this agent, and the optimal dosing strategy and administration approach has not been clearly established. [40][41][42][43] The purpose of our study was to evaluate the efficacy, safety and patient satisfaction of propofol for procedural sedation and analgesia in the ED of a large tertiary care teaching hospital.…”

Section: Résumémentioning

confidence: 99%

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

Zed

Abu‐Laban

Chan³

et al. 2007

CJEM

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

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

Zed

Abu‐Laban

Chan³

et al. 2007

CJEM

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“…45,46 Proponents suggest that, with careful titration and monitoring, trained emergency physicians can provide safe and effective procedural sedation using propofol. 43,44 Others feel that the evidence does not yet support its use in this setting.…”

Section: Adverse Effectsmentioning

confidence: 99%

Is propofol an optimal agent for procedural sedation and rapid sequence intubation in the emergency department?

Wilbur

Zed

2001

CJEM

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Objective:We conducted a qualitative systematic review to evaluate the efficacy and safety of propofol for direct current cardioversion (DCC), rapid sequence intubation (RSI) and procedural sedation in adult emergency department (ED) patients. Data source: MEDLINE (1966 to September 2000, PubMed (to September 2000), EMBASE (1988 to September 2000, Database of Systematic Reviews (to September 2000), Best Evidence (1991 to September 2000) and Current Contents (1996 to September 2000) databases. Study selection: English-language, randomized, comparative evaluations of propofol for procedures routinely conducted in adults (>18 years) were included. Direct current cardioversion, RSI and procedural sedation were considered. Data extraction: Efficacy and safety endpoints were evaluated for all trials. For DCC and procedural sedation trials, efficacy measures included induction and recovery times, as well as the association for successful procedure. For the RSI trials, optimal intubating conditions were evaluated as the primary efficacy endpoint. Safety measures included hemodynamic changes, apnea rates and adverse effects. Data synthesis: In the setting of DCC, efficacy and safety outcomes were similar for propofol, thiopental, etomidate and methohexital. All of these agents provided markedly shorter induction and recovery times than midazolam. Patients who were pre-medicated with fentanyl exhibited prolonged recovery times and greater decreases in blood pressure. When used for RSI, propofol administration was associated with satisfactory intubating conditions that were comparable to those seen with thiopental and etomidate. Blood pressure reductions were seen in both DCC and RSI studies. Apneic episodes (>30 seconds) occurred in 23% of propofol recipients, 28% of thiopental recipients and 7% of etomidate and midazolam recipients. Apart from the DCC studies described, no procedural sedation studies met our predefined review eligibility criteria. Conclusion:The body of literature evaluating propofol for DCC and RSI in the ED is limited. There is evidence to support the use of propofol for DCC and RSI, but this evidence comes from stable patients in non-ED settings. Further ED-based randomized comparative trials should be conducted before propofol is adopted for widespread use in the ED. RÉSUMÉObjectif : Nous avons mené une revue qualitative méthodique afin d'évaluer l'efficacité et l'innocuité du propofol pour la cardioversion, l'intubation à séquence rapide (ISR) et la sédation

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“…This drug is recommended for the control of renal colic in patients, especially when non-steroidal antiin ammatory drugs are contraindicated. [14][15][16] Another drug is Ketamine, which has anti-in ammatory properties in addition to anesthesia. It is also a pain reliever and has analgesic properties that distinguish it from other anesthetics.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the analgesic effect of Ketamine and Midazolam with Apotel and Ketorolac in renal colic patients: a clinical trial

Bahrami

Zareie

Jabbari

et al. 2022

Preprint

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Background: This study aimed to determine the effect of the Ketamine and Midazolam combination and compare it with the Apotel and Ketorolac combination in pain management of patients with renal colic in the emergency section.In this double-blind clinical trial study, 200 renal colic patients admitted to the ED with more than 8 NRS* (Numerical Rating Scale) of primary pain were divided into two groups by random blocking: one group received intravenous Ketamine (0.4 mg/kg), and intravenous Midazolam (at a dose of 0.016 mg/kg) and the other group received intravenous Ketorolac (30 mg) and intravenous Apotel (15 mg/kg). After that, we measured patients' pain at 1, 5, 10, 15, 30, and 45 min after the procedure.Results: 124 (62.0%) of 200 patients were men. Initial pain scores were 9(10-9) for Ketamine + Midazolam and 10(10-9) for Apotel + Ketorolac.Linear regression was performed to compare the two groups' adjusted pain scores, correcting for initial pain. The ultimate pain score increased by.392 units for each unit of starting pain. Group and time had significant effects (5.553, -.035, P=.001, respectively).Apotel + Ketorolac had a higher mean pain score than Ketamine + Midazolam at all post-intervention time intervals. During the trial, both groups' discomfort decreased dramatically.Conclusions: The combination of Ketamine and Midazolam was more effective than Apotel and Ketorolac in relieving the pain in renal colic. Therefore, if routine medications are contraindicated, a combination of Ketamine and Midazolam is recommended for pain control in patients with renal colic.Trial registration: This trial was registered in the Iranian Registry of Clinical Trials with IRCT registration number of IRCT20200422047163N1 (https://www.irct.ir/trial/47370) and registration date of 2020-05-01.

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Emergency department sedation guidelines: a tale of two specialties

Cited by 7 publications

References 10 publications

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

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

Is propofol an optimal agent for procedural sedation and rapid sequence intubation in the emergency department?

Comparison of the analgesic effect of Ketamine and Midazolam with Apotel and Ketorolac in renal colic patients: a clinical trial

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