Nursing use between 2 methods of procedural sedation: Midazolam versus propofol

Holger, Joel S.; Satterlee, Paul A.; Haugen, Stephanie

doi:10.1016/j.ajem.2005.01.001

Cited by 22 publications

(31 citation statements)

References 10 publications

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“…We found 4 RCTs that reported head-to-head comparisons of midazolam and propofol in the ED setting that could be used for the analysis of AEs and clinical effectiveness. 6,[10][11][12] We found 9 additional RCTs that did not report direct comparisons between the study drugs, but in which either midazolam or propofol had been studied and could be included in the analysis of AEs. 2,5,21,22,[29][30][31][32][33][34] An additional 15 observational studies met inclusion criteria for the analysis of AEs.…”

Section: Trial Flowmentioning

confidence: 99%

“…18 We received patient level data from two RCTs that reported head-tohead comparisons. 10,12 Clinical effectiveness, as measured by satisfaction scores, pain scores, and patient relaxation and recall, was reported inconsistently between trials and without the use of comparable quantitative scales. Therefore, these measures of clinical effectiveness could not be assessed.…”

Section: Study Protocolmentioning

confidence: 99%

“…Propofol remains more expensive, but is preferred by many physicians because it is associated with good patient relaxation and shorter recovery times. 6,[10][11][12] In contrast, some practitioners favor midazolam because they believe it may be associated with a lower risk of major AEs. 13,14 If, in fact, one of the two agents is associated with a more favorable safety profile and ⁄ or greater clinical effectiveness, the use of the superior agent should be encouraged.…”

mentioning

confidence: 99%

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Safety and Clinical Effectiveness of Midazolam versus Propofol for Procedural Sedation in the Emergency Department: A Systematic Review

Hohl

Sadatsafavi²,

Nosyk³

et al. 2008

Academic Emergency Medicine

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Objectives: To synthesize the evidence comparing the adverse event (AE) profile and clinical effectiveness of midazolam and propofol for procedural sedation (PS) in adults in the emergency care setting. Methods:The authors conducted a systematic review of randomized controlled trials (RCTs) and observational studies reporting the use of either midazolam and ⁄ or propofol for adult PS in the emergency department (ED). A systematic search strategy was developed and applied to six bibliographic reference databases. Three emergency medicine journals, the Canadian Adverse Drug Reaction Newsletter, and conference proceedings were hand-searched. Retrieved articles were reviewed and data were abstracted using standardized data collection. Trial quality was assessed using the Jadad score. The outcomes assessed were the proportion of patients with AEs and the pooled mean difference in the proportion of patients with successful PS.Results: Of 229 articles identified, 28 met the inclusion criteria for the analysis of AEs. Only one major AE to PS was found, resulting in no statistically significant difference in the proportion of major AEs between agents. Four studies were RCTs that met the inclusion criteria for the analysis of clinical effectiveness. Two trials met criteria for good quality. The RCTs enrolled between 32 and 86 patients, and the most common indications for PS were orthopedic reductions and cardioversions. There was a nonsignificant difference in the proportion of patients with successful PS in favor of propofol (effect difference 2.9%, 95% confidence interval (CI) = -6.5 to 15.2). Conclusions:The authors found no significant difference in the safety profile and the proportion of successful PS between midazolam and propofol for adults in the ED.ACADEMIC EMERGENCY MEDICINE 2008; 15:1-8 ª

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Section: Trial Flowmentioning

confidence: 99%

Section: Study Protocolmentioning

confidence: 99%

mentioning

confidence: 99%

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Safety and Clinical Effectiveness of Midazolam versus Propofol for Procedural Sedation in the Emergency Department: A Systematic Review

Hohl

Sadatsafavi²,

Nosyk³

et al. 2008

Academic Emergency Medicine

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“…[1][2][3] In North America, PSA agents were traditionally comprised of a combination of benzodiazepine sedatives and opioid analgesics. Prolonged onset and recovery times 4 delayed respiratory depression, 5 and the variable efficacy of these agents promoted the search for better options. 3,6,7 The use of propofol, ketamine and etomidate have become commonplace in the ED as a result.…”

Section: Introductionmentioning

confidence: 99%

“…15,16 Evidence supports the use of such agents even in settings outside the ED or operating room by supervised nurses or by physicians without formal advanced airway or cardiac life support training. 4,[16][17][18][19][20] Despite this, the risk of inadvertent deep sedation or general anesthesia, with the attendant respiratory and hemodynamic depression 3,21 has raised concerns about the safety of these drugs. Opinions as to their appropriateness in the ED vary in the literature.…”

Section: Introductionmentioning

confidence: 99%

Procedural sedation and analgesia in a Canadian adult tertiary care emergency department: a case series

Campbell

Magee

Kovács

et al. 2006

CJEM

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Objectives:To examine the safety of emergency department (ED) procedural sedation and analgesia (PSA) and the patterns of use of pharmacologic agents at a Canadian adult teaching hospital. Methods: Retrospective analysis of the PSA records of 979 patients, treated between Aug. 1, 2004, and July 31, 2005, with descriptive statistical analysis. This represents an inclusive consecutive case series of all PSAs performed during the study period. Results: Hypotension (systolic blood pressure ≤ 85 mm Hg) was documented during PSA in 13 of 979 patients (1.3%; 95% confidence interval [CI] 0.3%-2.3%), and desaturation (SaO 2 ≤ 90) in 14 of 979 (1.4%; CI 0.1%-2.7%). No cases of aspiration, endotracheal intubation or death were recorded. The most common medication used was fentanyl (94.0% of cases), followed by propofol (61.2%), midazolam (42.5%) and then ketamine (2.7%). The most frequently used 2-medication combinations were propofol and fentanyl (P/F) followed by midazolam and fentanyl (M/F), used with similar frequencies 58.1% (569/979) and 41.0% (401/979) respectively. There was no significant difference in the incidence of hypotension or desaturation between the P/F and M/F treated groups. In these patients, 9.1% (90/979) of patients received more than 2 different drugs. Conclusions: Adverse events during ED PSA are rare and of doubtful clinical significance. Propofol/fentanyl and midazolam/fentanyl are used safely, and at similar frequencies for ED PSA in this tertiary hospital case series. The use of ketamine for adult PSA is unusual in our facility.

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The use of propofol for procedural sedation in emergency departments

Wakai

Blackburn

McCabe

et al. 2015

Cochrane Database of Systematic Reviews

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No firm conclusions can be drawn concerning the comparative effects of administering intravenous propofol, with or without an adjunctive analgesic agent, with alternative interventions in participants undergoing PS in the ED setting on adverse effects (including pain at the injection site) and participant satisfaction. The review was limited because no two included studies employed the same comparator interventions, and because the number of participants in eight of the included studies were small (fewer than 100 participants).

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Nursing use between 2 methods of procedural sedation: Midazolam versus propofol

Cited by 22 publications

References 10 publications

Safety and Clinical Effectiveness of Midazolam versus Propofol for Procedural Sedation in the Emergency Department: A Systematic Review

Safety and Clinical Effectiveness of Midazolam versus Propofol for Procedural Sedation in the Emergency Department: A Systematic Review

Procedural sedation and analgesia in a Canadian adult tertiary care emergency department: a case series

The use of propofol for procedural sedation in emergency departments

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