Is propofol an optimal agent for procedural sedation and rapid sequence intubation in the emergency department?

Wilbur, Kerry; Zed, Peter J.

doi:10.1017/s1481803500005819

Cited by 27 publications

(22 citation statements)

References 47 publications

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“…23,24 Toward improving patient safety, this study was designed to determine whether administration of the AMPAKINE CX717 would offer protection against propofol-induced respiratory depression. The hypothesis is based on the fact that CX717 increases the strength and efficacy of glutamatergic neurotransmission via AMPARs that is essential for controlling neuronal excitability in key respiratory neuronal populations.…”

Section: Discussionmentioning

confidence: 99%

Coadministration of the AMPAKINE CX717 with Propofol Reduces Respiratory Depression and Fatal Apneas

et al. 2013

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Background: Propofol (2,6-diisopropylphenol) is used for the induction and maintenance of anesthesia in human and veterinary medicine. Propofol's disadvantages include the induction of respiratory depression and apnea. Here, the authors report a clinically feasible pharmacological solution for reducing propofol-induced respiratory depression via a mechanism that does not interfere with anesthesia. Specifically, they test the hypothesis that the AMPAKINE CX717, which has been proven metabolically stable and safe for human use, can prevent and rescue from propofol-induced severe apnea. Methods: The actions of propofol and the AMPAKINE CX717 were measured via (1) ventral root recordings from newborn rat brainstem-spinal cord preparations, (2) phrenic nerve recordings from an adult mouse in situ working heartbrainstem preparation, and (3) plethysmographic recordings from unrestrained newborn and adult rats. Results:In vitro, respiratory depression caused by propofol (2 μM, n = 11, mean ± SEM, 41 ± 5% of control frequency, 63 ± 5% of control duration) was alleviated by CX717 (n = 4, 50-150 μM). In situ, a decrease in respiratory frequency (44 ± 9% of control), phrenic burst duration (66 ± 7% of control), and amplitude (78 ± 5% of control) caused by propofol (2 μM, n = 5) was alleviated by coadministration of CX717 (50 μM, n = 5). In vivo, pre-or coadministration of CX717 (20-25 mg/kg) with propofol markedly reduced propofol-induced respiratory depression (n = 7; 20 mg/kg) and propofol-induced lethal apnea (n = 6; 30 mg/kg). Conclusions: Administration of CX717 before or in conjunction with propofol provides an increased safety margin against profound apnea and death. P ROPOFOL (2,6-diisopropylphenol) is used for the induction and maintenance of anesthesia in human and veterinary medicine. Propofol's favorable attributes are its pharmacokinetic properties that result in a rapid, clear emergence. Its disadvantages include the induction of respiratory depression, apnea, and blood pressure reductions.1,2 Furthermore, there are increasing reports What We Already Know about This Topic• Propofol depresses respiration partly due to the activation of γ-aminobutyric acid receptors within brainstem respiratory center AMPAKINEs effectively alleviates opioid-induced respiratory depression without interfering with analgesia in rodentsWhat This Article Tells Us That Is New Address correspondence to Dr. Greer: University of Alberta, Department of Physiology, Centre for Neuroscience, Women and Children's Health Research Institute, 3-020M Katz Building, Edmonton, Alberta, Canada T6G 2S2. john.greer@ualberta.ca. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology's articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.

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Section: Discussionmentioning

confidence: 99%

Coadministration of the AMPAKINE CX717 with Propofol Reduces Respiratory Depression and Fatal Apneas

et al. 2013

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“…Propofol has been used for procedural sedation in Emergency Medicine since 1995 7. In 1996, in a review article in Anaesthesia ,8 it was recommended as the drug which most closely approaches the ideal agent for cardioversion; however, a systematic review of the use of propofol for procedural sedation in Emergency Medicine in 2001 concluded that although there was evidence to support the use of propofol for DCCV this evidence came from stable patients in a non-ED setting, and there was as yet no evidence to support its use in emergency practice 9. Since then, Miner et al 10 have shown that procedural sedation in the ED with propofol appears to be safe in ASA class III and IV patients.…”

Section: Discussionmentioning

confidence: 99%

Procedural sedation with propofol for emergency DC cardioversion

Kaye

Govier

2013

Emerg Med J

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Many emergency patients present with cardiac arrhythmias requiring emergency direct current countershock cardioversion (DCCV) as a part of their management. Almost all require sedation to facilitate the procedure. Propofol has been used for procedural sedation in Emergency Medicine since 1995. In 1996, in a review article in Anaesthesia, it was recommended as the drug which most closely approaches the ideal agent for DCCV. However, the existing evidence for the dosage requirements and safety of propofol in emergency DCCV is limited. We report a prospective case series of patients who underwent sedation-facilitated DCCV using propofol in the emergency department with both sedation and DCCV delivered by emergency physicians. The results indicate propofol is a safe drug for procedural sedation to facilitate emergency DCCV in patients with an atrial tachyarrhythmia without any evidence of haemodynamic compromise. A dose of 1 mg/kg appears to be safe in the majority of these patients. Using the adverse event reporting tool produced by the World SIVA International Sedation Task Force there were no moderate or sentinel adverse events in these patients. A reduced dose should be considered in older patients to prevent transient complications. Propofol at a dose of 0.5 mg/kg appears to be a safe drug for procedural sedation to facilitate emergent or urgent DCCV in patients with an atrial tachyarrhythmia with evidence of haemodynamic compromise. There were no sentinel adverse events associated with its use. Evidence to support the use of propofol to facilitate emergency DCCV for ventricular tachycardia is limited.

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“…Based on the parameters evaluated in the present study, we can conclude Propofol as a superior sedating agent compared to Diazepam, having rapid onset and predictability of action, profoundness of amnesia and a faster recovery period, offering advantages of early patient discharge and better patient compliance [28].…”

Section: Resultsmentioning

confidence: 73%

Randomised Comparative Study on Propofol and Diazepam as a Sedating Agent in Day Care Surgery

Nirwan¹,

Jain

Pragasm

et al. 2013

J. Maxillofac. Oral Surg.

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Objective The study was conducted to assess the usefulness by qualitative comparison between the two intravenous sedative drugs, Diazepam and Propofol and to provide sedation in apprehensive and uncooperative patients undergoing day care oral surgical procedures. Methods The present study was conducted on 20 adult patients, 10 in each group (Propofol and Diazepam) irrespective of age and sex. Intravenous sedation of Propofol compared with Diazepam in terms of onset of action, recovery, and anterograde amnesia, patient co-operation, surgeon's convenience and side effects and other parameters. Results Propofol was found to be the superior sedating agent compared to Diazepam, having rapid onset and predictability of action, profoundness of amnesia and a faster recovery period, offering advantages of early patient discharge and better patient compliance. Conclusion Propofol was found to be an ideal sedating agent in day care oral surgical procedures.

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Is propofol an optimal agent for procedural sedation and rapid sequence intubation in the emergency department?

Cited by 27 publications

References 47 publications

Coadministration of the AMPAKINE CX717 with Propofol Reduces Respiratory Depression and Fatal Apneas

Coadministration of the AMPAKINE CX717 with Propofol Reduces Respiratory Depression and Fatal Apneas

Procedural sedation with propofol for emergency DC cardioversion

Randomised Comparative Study on Propofol and Diazepam as a Sedating Agent in Day Care Surgery

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