Clinical Practice Advisory: Emergency Department Procedural Sedation With Propofol

Changing Trends in Dental Procedural Sedation

“…Because of behavioral constraints, sedation by bolus oral administration is well tolerated and routine; but sedation depth with oral medication is difficult to predict and impossible to titrate the dose [13,68,69] . However, with development of technology and better pharmacologic profile of modern drugs in new ways with high success, newer alternate routes has been proposed and investigated such as transmucosal (intranasal, buccal, sublingual) which has much less discomfort than intravenous route with faster and predictable action than oral sedation [66] . Midazolam is the most frequently used sedative agent in pediatric and can be administered via various route (oral, nasal, rectal, intramuscular, intravenous).…”

“…Patients with extreme of age: Limited organ reserve-risk of over-sedation [65][66][67] . Paediatric consideration: The choice and selection of agent for pediatric procedural sedation differ slightly.…”

Comparing the pain of propofol via different combinations of fentanyl, sufentanil or remifentanil in gastrointestinal endoscopy

“…However, propofol injection frequently causes local pain or discomfort that sometimes induces distress to patients 6,7 . Novel approach to propofol administration in combination with opioids has been proposed to improve sedation and analgesia [8][9][10][11] . Fentanyl is a potent, synthetic opioid analgesic with a rapid onset and short duration of action, and is commonly used in preprocedures as a pain reliever as well as an anesthetic in combination with a benzodiazepine 12 .…”

Propofol Sedation Exacerbates Kidney Pathology and Dissemination of Bacteria during Staphylococcus aureus Bloodstream Infections

“…Propofol is one of the most common anesthetic agents used in the induction and maintenance of anesthesia prior to surgery, both in the intensive care unit (ICU) and in routine outpatient procedures (17)(18)(19)(20). This is in part due to its low incidence of anesthesia-related side effects and the short half-life of the drug (21-23), but some …”

“…Despite numerous measures taken to ensure sterility and limit spread of MRSA from health care workers to patients in hospitals (12, 13), the rate of infection remains high (14,15). While significant effort is generally focused on enforcing aseptic technique as a method to prevent infection, there may be additional factors that influence the frequency and/or severity of nosocomial infections (16).Propofol is one of the most common anesthetic agents used in the induction and maintenance of anesthesia prior to surgery, both in the intensive care unit (ICU) and in routine outpatient procedures (17)(18)(19)(20). This is in part due to its low incidence of anesthesia-related side effects and the short half-life of the drug (21-23), but some …”