The Effect of the Assignment of a Pre-Sedation Target Level on Procedural Sedation Using Propofol

Miner, James R.; Huber, Darren; Nichols, Scott P.; Biros, Michelle H.

doi:10.1016/j.jemermed.2006.07.023

Cited by 21 publications

(9 citation statements)

References 17 publications

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“…Although in an ideal world it might be prudent to only sedate patients to moderate sedation level, pre-determined sedation targets are hard to achieve 8. Furthermore, many practitioners may feel that this level of sedation is inappropriately light for many orthopaedic manipulations.…”

Section: Discussionmentioning

confidence: 99%

Procedural sedation and analgesia in a large UK Emergency Department: factors associated with complications

Jacques

Dewar

Gray

et al. 2010

Emergency Medicine Journal

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Section: Discussionmentioning

confidence: 99%

Procedural sedation and analgesia in a large UK Emergency Department: factors associated with complications

Jacques

Dewar

Gray

et al. 2010

Emergency Medicine Journal

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“…compared a targeted moderate sedation to deep sedation for propofol ED PSA. Recall was 6/43 (14%) for deep sedation and 10/32 (31%) for moderate sedation ( P = 0.07), and adverse respiratory events were similar for both groups . Therefore, a moderate sedation may be associated with increased recall without improved safety compared to a deep sedation, an important signal that warrants further evaluation via RCT.…”

Section: Discussionmentioning

confidence: 91%

“…Recall was 6/43 (14%) for deep sedation and 10/32 (31%) for moderate sedation (P = 0.07), and adverse respiratory events were similar for both groups. 21 Therefore, a moderate sedation may be associated with increased recall without improved safety compared to a deep sedation, an important signal that warrants further evaluation via RCT. Our data demonstrated a significant association between propofol doses <0.75 mg/kg and memory, an expected finding in keeping with the dose-dependent anaesthetic effect of propofol.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with patient‐reported procedural memory following emergency department procedural sedation with ketamine and propofol: A prospective cohort of 563 patients

Greer

Treston

2017

Emerg Medicine Australasia

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“…The ETCO 2 monitor (Capnostream 20, Oridion Capnography Inc., Bedford, MA) displays a continuous numerical ETCO 2 value and waveform. Additionally, patients were also placed on a bispectral electroencephalogram (EEG) monitor in order to monitor their level of awareness . Patients were given supplemental oxygen by face mask prior to the start of the procedure.…”

Section: Methodsmentioning

confidence: 99%

Randomized Clinical Trial of the Effect of Supplemental Opioids in Procedural Sedation with Propofol on Serum Catecholamines

Miner

Moore

Plummer

et al. 2013

Academic Emergency Medicine

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Objectives The objective was to assess the effect on stress biomarkers of supplemental opioid to a standard propofol dosing protocol for emergency department (ED) procedural sedation (PS). The hypothesis was that there is no difference in the change in serum catecholamines between PS using propofol with or without supplemental alfentanil. Methods This was a randomized, nonblinded pilot study of adult patients undergoing PS in the ED for the reduction of fractures and dislocations. Patients with pain before the procedure were treated with intravenous (IV) morphine sulfate until their pain was adequately treated for at least 20 minutes before starting the procedure. Patients were randomized to receive either 10 μg/kg alfentanil followed by 1 mg/kg propofol, followed by 0.5 mg/kg every 3 minutes as needed, or propofol only, dosed in similar fashion without supplemental alfentanil. Doses, vital signs, nasal end‐tidal CO2 (ETCO2), pulse oximetry, and bispectral electroencephalogram (EEG) analysis scores were recorded. Subclinical respiratory depression was defined as a change in ETCO2 > 10 mm Hg, an oxygen saturation of < 92% at any time, or an absent ETCO2 waveform at any time. Clinical events related to respiratory depression were noted during the procedure, including the addition of or increase in the flow rate of supplemental oxygen, the use of a bag–valve–mask apparatus, airway repositioning, or stimulation to induce breathing. Blood was drawn 1 minute prior to the administration of the medications for PS and again 1 minute after completion of the procedure for which the patient was sedated. Serum was tested for total catecholamines, epinephrine, norepinephrine, and dopamine. Postprocedure, patients were asked to report any pain perceived during the procedure. Data were analyzed using descriptive statistics, Wilcoxon rank sum tests, and chi‐square tests, as appropriate. Results Twenty patients were enrolled; 10 received propofol and 10 received propofol with alfentanil. No clinically significant complications were noted. Subclinical respiratory depression was seen in four of 10 (40%) patients in the propofol group and five of 10 (50%) patients in the propofol/alfentanil group (effect size = −10%, 95% confidence interval [CI] = −53% to 33%). There was no difference in the rate of clinical signs of respiratory depression between the two groups. Pain during the procedure was reported by two of 10 (20%) patients in the propofol group and five of 10 (50%) patients in the propofol/alfentanil group (effect size = −30%, 95% CI = −70% to 10%). Recall of some part of the procedure was reported by 0 of 10 (0%) patients in the propofol group and five of 10 (50%) of patients in the propofol/alfentanil group (effect size = −50%, 95% CI = −81% to −19%). There was no difference in the baseline or postprocedure catecholamine levels between the groups. Conclusions No difference in serum catecholamines was detected immediately after PS between patients who receive propofol with and without supplemental opioid in this small...

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The Effect of the Assignment of a Pre-Sedation Target Level on Procedural Sedation Using Propofol

Cited by 21 publications

References 17 publications

Procedural sedation and analgesia in a large UK Emergency Department: factors associated with complications

Procedural sedation and analgesia in a large UK Emergency Department: factors associated with complications

Factors associated with patient‐reported procedural memory following emergency department procedural sedation with ketamine and propofol: A prospective cohort of 563 patients

Randomized Clinical Trial of the Effect of Supplemental Opioids in Procedural Sedation with Propofol on Serum Catecholamines

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