Is it safe to use propofol in the emergency department? A randomized controlled trial to compare propofol and midazolam

Abstract

BackgroundThis study examined the safety and effectiveness of the procedural sedation analgesia (PSA) technique carried out in the emergency department (ED) of a university hospital over a period of 1 year. The research was done to compare the effectiveness and efficacy of moderate sedation of fentanyl combined with either midazolam or propofol for any brief, intense procedure in the ED setting.AimsThe objectives were to observe the occurrence of adverse events in subjects undergoing PSA for intense and painful procedures in the emergency department and to implement the use of capnography as a method of monitoring the patients when they were under PSA.MethodsForty patients were selected for this study. They were randomly divided into two equal groups using the computer-generated random permuted blocks of four patients. Twenty patients were grouped together as group A and the remaining 20 patients as group B. Drugs used were single blinded to prevent any bias. Drug A was propofol and fentanyl, while drug B was midazolam and fentanyl. The procedures involved included orthopedic manipulation such as reduction of fractures, reduction of dislocated joints, abscess drainage, wound debridement, laceration wound repair and cardioversion. All of the subjects were monitored for their vital signs and end tidal carbon dioxide level every 10 min till the PSA was completed. The duration of stay in the ED was documented when the subjects had completed the procedure and were released from the department.ResultOf the study population, 75.6% were males. The mean age was 37.8 years (95% CI 33.2, 39.8). None of the patients developed any major complications while under PSA. The vital signs pre-, intra- and post-procedure were not significantly different in either the propofol or mizadolam groups (p value >0.05).ConclusionThis study had proven that there was no difference in adverse event occurrence between the studied drugs during PSA. Propofol can be recommended for use in PSA if the operator is well trained and familiar with the drug.

Evaluation of the compliance between EEG monitoring (Bispectral IndexTM) and Ramsey Sedation Scale to measure the depth of sedation in the patients who underwent procedural sedation and analgesia in the emergency department

“…No correlation was observed between the type of drug (midazolam, propofol, and their combinations) and the presence of complication in the present study, which was consistent with other similar studies. [9,[16][17][18][19] According to the present study and other previous studies, the sedation level determined the risk of complication in PSA rather than the type or dose of the drug. It can be concluded that effective PSA monitoring reduces the risk of complications irrespective of the drug dose.…”

Complications of IV sedation for dental treatment in individuals with intellectual disability

“…Age could not be stratified because the subjects recruited were adults in the study of Rahman and Hashim [34], while age and psychological maturity can affect emergence agitation in the study of Picard and his colleagues [3]. Minor complications were recorded in children under 16 years, all patients with intellectual disability in the study of Ransford and his colleagues [21].…”

Propofol for sedation for direct current cardioversion

“…Among randomized studies,[11121314151617181920212223242526] the outcomes investigated are heterogeneous. Furthermore, the doses and also the professional leading the anesthesia were different in many cases, which could have influenced their results [Table 2].…”

“…[15161718] When compared with midazolam, one study showed that the decrease in systolic blood pressure was more pronounced with propofol,[19] while others did not report difference. [10131420] It must be highlighted that even in studies that presented statistically significant reduction in blood pressures, no relevant clinical effect was found. In addition, elderly patients with structural heart diseases showed to be more prone to hypotension, especially when fentanyl was administrated along with propofol.…”