Anterior Shoulder Dislocation Reduction Managed Either with Midazolam or Propofol in Combination with Fentanyl

Abstract

Objective: Procedural Sedation and Analgesia is used in managing emergency painful procedures. The aim of this study is to compare the effects of propofol and midazolam on haemodynamic parameters when used in combination with fentanyl in isolated anterior shoulder dislocations and to measure the patient and physician satisfactions. Methods: The study is a randomised single blind prospective trial. All procedural sedations were performed by emergency medicine specialists and the shoulder reductions were performed by orthopaedic surgeons. Two groups were defined. Group A received intravenous fentanyl and midazolam and Group B received intravenous fentanyl and propofol. The orthopaedic surgeons were not informed about the drugs. The emergency medicine specialist observed the patients. The patients and the orthopaedic surgeons were asked for a satisfaction scoring. Results: Midazolam group consisted of 37 patients and propofol group consisted of 38 patients. Both groups were similar in demographic characteristics and pre-procedural vital signs. There was only one statistically significant difference at one time and it was the 5th minutes SpO 2 levels between groups. There were statistically significant changes in the measurements of vital parameters in both groups when compared with the baseline levels. However none of them was clinically important. In midazolam and propofol group, 10.8% and 10.5% respectively had respiratory compromise. Patient and physician satisfactions were similar in both groups. Conclusions: Midazolam and propofol are both relatively safe drugs using in combination with fentanyl in anterior shoulder dislocations. Patients and physicians can be highly satisfied with the two groups of drugs. (Hong Kong j.emerg.med. 2014;21:346-353) 目的：程序鎮靜和止痛常使用在處理急診中引起痛楚的手術程序。本研究的目的是在孤立的前肩脫位使 用芬太尼時，比較異丙酚和咪達唑崙對血液動力學參數的影響，並測量患者和醫生的滿意度。方法：本 研究是一項隨機單盲前瞻性研究。所有的鎮靜程序都由急診專科醫生負責，肩關節復位由骨科醫生進 行。患者分為兩組。 A 組接受靜脈注射芬太尼和咪達唑崙， B 組靜脈注射芬太尼和丙泊酚。骨科醫生沒 有被告知使用的藥物。急診專科醫生負責觀察患者。病人和骨科醫生會被詢問有關滿意度得分。結果： 咪達唑崙組有 37 例，丙泊酚組有 38 例。兩組患者的人口統計學特徵和進行程序前的生命體徵相似。只 有第 5 分鐘的血氧飽和度，兩組之間有一個統計上顯著差異。與基線水平相比，兩組的生命體徵參數測 量到有統計學上的顯著變化。但是他們臨床上都不是重要的。在咪達唑崙和異丙酚組，分別有 10.8% 和

Incidence of Adverse Events in Adults Undergoing Procedural Sedation in the Emergency Department: A Systematic Review and Meta‐analysis

“…After screening the titles and abstracts and removing duplicates, we identified 465 potentially relevant studies. After full‐text review, 55 articles met inclusion criteria . Interobserver agreement (kappa) for phase II of the review was 0.99 (95% CI = 0.98 to 1.0).…”

“…The incidence was 40.2 per 1,000 sedations (95% CI = 32.5 to 47.9). The incidence was highest with the use of propofol (19.1 per 1,000 sedation, 95% CI = 12 to 26.3) and midazolam/opiate (15.4 per 1,000 sedations, 95% CI = 2.1 to 28.8; see Figure for the forest plot for hypoxia).…”

“…Forest plot of the proportion of patients experiencing hypoxia, by medication. E = etomidate; K = ketamine; KP = ketamine/propofol; M = midazolam; MO = midazolam/opiate; O = opiate; P = propofol …”

“…In the 95 minutes before sedation, he received morphine, fentanyl, and lorazepam intravenously. The other case was intubation after aspiration in a patient that underwent sedations for an ankle fracture (see Figure for the forest plot for intubation).…”