Propofol for procedural sedation in children in the emergency department

Bassett, Kathlene E.; Anderson, Jana L.; Pribble, Charles G.; Guenther, Elisabeth

doi:10.1016/s0196-0644(03)00619-x

Cited by 187 publications

(104 citation statements)

References 39 publications

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“…4,12 Although sedation end points vary among other published studies, our findings are consistent with the many reports that propofol has a shorter sedation time than midazolam. 4,5,8,9,12 Intuitively, shorter sedation times are likely to be associated with shorter periods when protective reflexes (especially airway) may be adversely affected. While this appears to be advantageous, it does not account for the degree of effect on these reflexes.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, respiratory depression, which has been reported in up to 49% of patients receiving propofol, [14][15][16][17] leads to apnea in up to 22% 4,[8][9][10]14,18 and hypoxia in up to 44% of patients. 4,5,8,9,14,[16][17][18][19] Other reports indicate that assisted ventilation is required in ,10% of patients 16,17 and that repositioning of the patient to correct partial airway obstruction is required in ,5% of patients. 8,14 Our experience with respiratory difficulties in this study is consistent with the reports of others.…”

Section: Discussionmentioning

confidence: 99%

“…Its reported advantages over midazolam include more rapid and deeper sedation, intense muscle relaxation, and shorter recovery time. [4][5][6][7] It is now evident that propofol is being used increasingly in emergency departments (EDs) for painful procedures (cardioversion, 4 orthopedic manipulation, [8][9][10] bone marrow aspiration, 9 abscess drainage, 10 chest tube placement 10 ) and cases in which anxiolysis or immobilization is required (ocular burn examination, 8 intrathecal medical administration, 9 lumbar puncture, 9 central line placement 9 ). Green and Krauss have recently reviewed the use of propofol in this setting.…”

mentioning

confidence: 99%

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Propofol versus Midazolam/Fentanyl for Reduction of Anterior Shoulder Dislocation

et al. 2005

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Objective: The authors aimed to compare propofol and midazolam/fentanyl for reduction of anterior shoulder dislocations using the modified Kocher's maneuver. Methods: This was a multicenter, randomized, clinical trial of patients with anterior shoulder dislocation. Patients were randomized to either propofol or midazolam/fentanyl. The randomized drug was titrated to a clinical sedation end point (spontaneous eye closure). One physician sedated the patient. Another, blinded to the drug administered, reduced the shoulder and recorded details of muscle tone and ease of reduction. Results: Eighty-six patients were randomized to treatment with propofol (n = 48) or midazolam/fentanyl (n = 38). Patients in the propofol group had shorter mean times to first wakening (difference in means, 4.6 minutes; 95% confidence interval [CI] = 0.7 to 8.6; p = 0.097) and full consciousness (difference in means, 21.7 minutes; 95% CI = 14.7 to 28.7; p , 0.001), had easier shoulder reduction (difference in mean rating, 0.5; 95% CI = 0.0 to 0.9; p = 0.047), and needed fewer reduction attempts (difference in means, 0.5; 95% CI = 0.1 to 1.0; p = 0.02). Patients in the propofol group also had less mean muscle tone at the first reduction attempt (p = 0.08) and needed fewer reduction maneuvers (p = 0.40) but had more respiratory depression (11 vs. six patients; difference in proportions, 7.1%; 95% CI = 211.8 to 26.1; p = 0.58) and had one patient who vomited. Conclusions: Propofol appears to be as effective as midazolam/fentanyl for reduction of anterior shoulder dislocation using the modified Kocher's maneuver. However, the advantage of shorter wakening times associated with propofol should be weighed against the possibility of adverse events, particularly respiratory depression and vomiting.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Propofol versus Midazolam/Fentanyl for Reduction of Anterior Shoulder Dislocation

et al. 2005

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“…The decrease in blood pressure we observed among patients receiving propofol is more pronounced than in previous reports. 4,12 It may be that in critically ill patients the capacity to compensate for the cardiodepressive effects of propofol is diminished.…”

Section: Discussionmentioning

confidence: 99%

Procedural Sedation of Critically Ill Patients in the Emergency Department

Miner

Martel

Meyer

et al. 2005

Academic Emergency Medicine

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Objectives: Procedural sedation is routinely performed in the emergency department (ED). However, some authors believe it is unsafe in nonintubated, critically ill patients. The objective of this study was to determine the safety of ED procedural sedation in the American Society of Anesthesiologists (ASA) physical status classification P3 and P4 patients. Methods: This was a prospective observational study of patients undergoing procedural sedation in the ED between August 2002 and December 2003 who were classified as ASA physical status score P3 or P4. Patients received either propofol or etomidate at the discretion of the treating physician before their painful procedure. Doses, vital signs, endtidal CO 2 (ETCO 2 ) by nasal cannulae, and pulse oximetry were recorded. Respiratory depression (RD) was defined as a change from baseline ETCO 2 .10 mm Hg, an oxygen saturation of ,90%, or an absent ETCO 2 waveform at any time. Results: Sixty-two critically ill, nonintubated patients were enrolled. Thirty-one patients received propofol, and 31 patients received etomidate. No cardiac rhythm abnormalities were detected. RD was seen in 37 of 62 patients (59.7%): 19 of the 31 (61.3%) who received propofol and 18 of the 31 (58.1%) who received etomidate. The mean decrease from baseline systolic blood pressure was 11.3% (95% confidence interval [CI] = 7.3% to 15.5%): 5.0% (95% CI = 3.0% to 8.1%) for those receiving etomidate and 17.1% (95% CI = 9.9% to 24.3%) for those receiving propofol. No adverse events were reported. Conclusions: The rate of subclinical RD detected by these criteria was similar to previous reports for noncritically ill patients. Procedural sedation of nonintubated ASA physical status score P3 and P4 patients in the ED with either propofol or etomidate appears to be safe.

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“…[1][2][3] Propofol's advantages include its rapid onset, short recovery time, and antiemetic effects. 4,5 Additionally, the ability to reliably produce sedation and amnesia makes it well-suited to emergency department (ED) practice.…”

mentioning

confidence: 99%

A Prospective Case Series of Pediatric Procedural Sedation and Analgesia in the Emergency Department Using Single‐syringe Ketamine–Propofol Combination (Ketofol)

Andolfatto

Willman

2010

Academic Emergency Medicine

103

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Objectives: This study evaluated the effectiveness, recovery time, and adverse event profile of intravenous (IV) ketofol (mixed 1:1 ketamine-propofol) for emergency department (ED) procedural sedation and analgesia (PSA) in children.Methods: Prospective data were collected on all PSA events in a trauma-receiving, community teaching hospital over a 3.5-year period, from which data on all patients under 21 years of age were studied. Patients receiving a single-syringe 1:1 mixture of 10 mg ⁄ mL ketamine and 10 mg ⁄ mL propofol (ketofol) were analyzed. Patients received ketofol in titrated aliquots at the discretion of the treating physician. Effectiveness, recovery time, caregiver and patient satisfaction, drug doses, physiologic data, and adverse events were recorded.Results: Ketofol PSA was performed in 219 patients with a median age of 13 years (range = 1 to 20 years; interquartile range [IQR] = 8 to 16 years) for primarily orthopedic procedures. The median dose of medication administered was 0.8 mg ⁄ kg each of ketamine and propofol (range = 0.2 to 3.0 mg ⁄ kg; IQR = 0.7 to 1.0 mg ⁄ kg). Sedation was effective in all patients. Three patients (1.4%; 95% confidence interval [CI] = 0.0% to 3.0%) had airway events requiring intervention, of which one (0.4%; 95% CI = 0.0% to 1.2%) required positive pressure ventilation. Two patients (0.9%; 95% CI = 0.0% to 2.2%) had unpleasant emergence requiring treatment. All other adverse events were minor. Median recovery time was 14 minutes (range = 3 to 41 minutes; IQR = 11 to 18 minutes). Median staff satisfaction was 10 on a 1-to-10 scale.Conclusions: Pediatric PSA using ketofol is highly effective. Recovery times were short; adverse events were few; and patients, caregivers, and staff were highly satisfied.

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Propofol for procedural sedation in children in the emergency department

Cited by 187 publications

References 39 publications

Propofol versus Midazolam/Fentanyl for Reduction of Anterior Shoulder Dislocation

Propofol versus Midazolam/Fentanyl for Reduction of Anterior Shoulder Dislocation

Procedural Sedation of Critically Ill Patients in the Emergency Department

A Prospective Case Series of Pediatric Procedural Sedation and Analgesia in the Emergency Department Using Single‐syringe Ketamine–Propofol Combination (Ketofol)

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