Article Text

PDF

Use of propofol for sedation in the emergency department
  1. Rupert Jackson,
  2. Simon Carley
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
  1. Correspondence to: Kevin Mackway-Jones, Consultant (kevin.mackway-jones{at}man.ac.uk)

Statistics from Altmetric.com

Report by Rupert Jackson; Specialist RegistrarChecked by Simon CarleySpecialist Registrar

Clinical scenario

A 35 year old man presents with a dislocated shoulder. You are about to undertake the reduction under sedation in the emergency department and wonder whether the use of a propofol infusion rather than boluses of midazolam would give effective sedation with shorter recovery time without compromising safety.

Three part question

In [patients requiring conscious sedation for short painful procedures] does [propofol compared with midazolam] give [shorter recovery times whilst being safe and effective]?

Search strategy

Medline 1966- July 2001 using the Ovid interface. {exp propofol/ OR “propofol”.mp} and {exp midazolam/ OR “midazolam”.mp OR exp diazepam/ OR “diazepam”.mp. OR exp lorazepam/ OR “lorazepam”.mp. OR exp benzodiazepines/ OR “benzodiazepine$”.mp.} AND {exp conscious sedation/ OR “sedation”.mp OR exp manipulation, orthopedic/ OR “manipulation”.mp OR “reduction”.mp. OR exp dislocations/ OR “dislocation”.mp. OR exp fractures, closed/ OR exp fractures/ OR “fractures”.mp. OR exp abscess/ OR “abscess”.mp.OR “incision”.mp. OR exp electric countershock/ OR “cardioversion”.mp.} AND maximally sensitive RCT filter limit to human AND english.

Search outcome

Altogether 220 papers were identified of which one compared the use of propofol with midazolam in the emergency department. A further three papers compared the two agents in other settings for conscious sedation for short procedures. While not directly applicable to the emergency department these have been included as they are applicable to the three part question. These four papers are shown in table 4.

Table 4

Comments

The routine use of propofol for sedation by non-anaesthetists is not currently accepted practice. Sedation by any means has inherent risks and there must be adequate resuscitation equipment and skilled staff available. Adverse events will occur more quickly with propofol than with midazolam, but they will also resolve more quickly. The papers confirm the efficacy and safety of propofol for conscious sedation and the shorter onset and recovery times are a major advantage.

Clinical bottom line

From the available evidence it seems that sedation with propofol in the emergency department is safe, effective, and dramatically reduces recovery times. The use of this agent should be considered.

Report by Rupert Jackson; Specialist RegistrarChecked by Simon CarleySpecialist Registrar

References

View Abstract

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.