Propofol versus Midazolam for Procedural Sedation of Anterior Shoulder Dislocation in Emergency Department

Hatamabadi, Hamid Reza; Dolatabadi, Ali Arhami; Derakhshanfar, Hojjat; Younesian, Somaye; Shad, Ensieh Ghaffari

doi:10.5812/traumamon.13530

Cited by 18 publications

(11 citation statements)

References 13 publications

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“…The finding could be explained by deeper levels of sedation for propofol and more prolonged sedation for midazolam. The current study findings were similar to previous reports in this field (21-23).…”

Section: Discussionsupporting

confidence: 93%

Comparison of the Sedation Quality of Etomidate, Propofol, and Midazolam in Combination with Fentanyl During Phacoemulsification Cataract Surgery: A Double-Blind, Randomized, Controlled, Clinical Trial

et al. 2019

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Background According to the favorable effects of combination therapy to provide better sedation during phacoemulsification and lack of any studies investigating the sedative effect of etomidate, propofol, and midazolam in combination with fentanyl during the procedure. Objectives The current study aimed at comparing the sedative properties of the mentioned three combination therapies in this field. Methods The current double-blind, randomized, controlled clinical trial was conducted on patients referred for elective phacoemulsification surgery under sedation. They were randomly allocated to the three groups to receive fentanyl plus one of the following medications: Propofol, midazolam, and etomidate. Demographic characteristics, medical condition, and hemodynamic parameters before, during, and after surgery, sedation level, anesthetic complications, sedation-related adverse events, and patients’ and surgeons’ satisfaction were evaluated and recorded by the anesthesiologist and compared in the three studied groups. Results In the current study, out of 150 enrolled patients, 98 completed the study. Frequency of different levels of Ramsay scores was not significantly different between the groups (P = 0.41). Frequency of Ramsay scores 3 and 4 was 92%, 79.4%, and 88.2% in etomidate, midazolam and propofol groups, respectively (P = 0.32). The median recovery time was significantly higher in the midazolam group than the propofol group (P = 0.04); intergroup comparisons indicated that the patients’ mean score of satisfaction in the propofol group was significantly higher than that of the etomidate group (P = 0.006). Conclusions The current study findings indicated that though the quality of sedation during phacoemulsification cataract surgery was acceptable in the three agents and the results had no significantly differences among the groups, and considering other factors including recovery time, hemodynamic evaluation, sedation-related complications, and patients’ satisfication scores, it is suggested that propofol was superior to the other two agents.

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Section: Discussionsupporting

confidence: 93%

Comparison of the Sedation Quality of Etomidate, Propofol, and Midazolam in Combination with Fentanyl During Phacoemulsification Cataract Surgery: A Double-Blind, Randomized, Controlled, Clinical Trial

et al. 2019

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“…Ultimately, we observed that administration of propofol or midazolam did not change the incidence rates of nausea and vomiting. This finding is consistent with those of other studies ( 31 ).…”

Section: Discussionsupporting

confidence: 94%

Intravenous Midazolam as More Effective Than Propofol for Preventing Pruritus After Intrathecal Sufentanil in Surgical Patients: A Randomized Blinded Trial

et al. 2016

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BackgroundPruritus is a troublesome side effect of intrathecal opioids. Midazolam can reinforce GABA-mediated inhibition of the medullary dorsal horn neurons, and thus theoretically has potential to suppress opioid-induced pruritus.ObjectivesThis prospective double-blinded randomized trial aimed at comparing the effects of propofol, midazolam, and a combination of the two on the prevention of pruritus induced by intrathecal sufentanil.MethodsEighty-four patients undergoing spinal anesthesia with 3 mL hyperbaric bupivacaine 0.5% and 5 μg sufentanil (1 mL) were randomly allocated to one of the three study groups: Group 1, who were administered 20 mg intravenous (IV) propofol bolus, then 50 μg/kg/min IV infusion; Group 2, who were administered 0.03 mg/kg IV midazolam bolus, then 0.02 mg/kg/h IV infusion; and Group 3, who were administered 10 mg IV propofol and 0.015 mg/kg IV midazolam bolus, then 25 μg/kg/min propofol and 0.01 mg/kg/h midazolam IV infusion. The incidence rates and severity of pruritus were assessed intraoperatively and postoperatively for 24 hours.ResultsThe Ramsay Sedation Score was highest for the propofol group throughout the duration of the anesthetic process. Overall, 17 patients in the propofol group (60.7%), eight patients in the midazolam group (28.6%), and nine patients in the propofol-midazolam group (32.1%) developed pruritus (P = 0.027). Intraoperative pruritus was observed in seven patients in the propofol group (25%), two patients in the midazolam group (7.1%), and five patients in the midazolam-propofol group (17.9%) (P = 0.196). Postoperative pruritus developed in 12 patients in the propofol group (42.9%), six patients in the midazolam group (21.4%), and four patients in the midazolam-propofol group (14.3%) (P = 0.041). There was no significant difference between the groups with respect to the severity of pruritus (P > 0.05).ConclusionsThis study showed that in comparison with propofol, the administration of 0.03 mg/kg IV midazolam bolus followed by 0.02 mg/kg/h could be more effective in the prevention of intrathecal sufentanil-induced pruritus without increasing sedation and other side effects.

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“…Even though the patients' prolonged stays at the crowded emergency departments are not preferred, providing patient comfort and the sufficient muscle relaxation might decrease the possible complications. In the literature, proper monitorization and airway management together with the application of intravenous analgesia and a sedative agent were recommended as a proper method for sufficient sedation in shoulder dislocations (14,15).…”

Section: Discussionmentioning

confidence: 99%

Acil Serviste Omuz Çıkıklarının Değerlendirilmesi: Sedoanaljezi ve İzlem

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Acar

et al. 2018

Osmangazi̇ Journal of Medicine

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Glenohumoral joint is the most mobile joint in the body and its dislocation is the most frequently seen large joint dislocation in the emergency department. Pain relief and overcoming muscle resistance are keys to a successful reduction. Although a reduction with an appropriate sedoanalgesia prolongs the hospital stay, it improves the success of the procedure and the patient's comfort. The aims of this study are to investigate the lengths of stay at the emergency department for the patients, who had dislocation diagnosis and reduction procedure, and the success of emergency department physicians in reduction procedures. The cases of the patients, who admitted to Eskisehir Osmangazi University School of Medicine, department of emergency medicine between 01.03.2011 and 01.03.2013, were identified as S40-S49 pursuant to ICD 10 coding system, and were over 18 years of age, were browsed retrospectively. The epidemiologic data of the patients, the applied analgesia and the sedation types, the clinic which administered them and their success rates were recorded. The collected data were evaluated statistically. Of 103 patients included to the study, 85 patients (82.5%) were male and their average age was 37.62 ± 16.93. Of 73 patients for whom the emergency physician tried closed reduction, the procedure was successful and there were no complications in 68 (93.1%). When the lengths of stay at the emergency department were compared in patients administered sedation and those not, it was detected that the patients who had sedation stayed significantly longer at the emergency department (p=0.001). It was detected that the patients stayed significantly shorter at the emergency department even though they had sedoanalgesia (p<0.001), when the reduction procedures were performed by the emergency physicians. Sedoanalgesia administered for shoulder reduction prolongs the patients' lengths of stay at the emergency department. However, the application of shoulder reduction with sedoanalgesia in a fitting patient group by emergency department physicians would improve success rate and decrease unnecessary consultations, pain and anxiety in patients, and their lengths of stay at the emergency department.

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Propofol versus Midazolam for Procedural Sedation of Anterior Shoulder Dislocation in Emergency Department

Cited by 18 publications

References 13 publications

Comparison of the Sedation Quality of Etomidate, Propofol, and Midazolam in Combination with Fentanyl During Phacoemulsification Cataract Surgery: A Double-Blind, Randomized, Controlled, Clinical Trial

Comparison of the Sedation Quality of Etomidate, Propofol, and Midazolam in Combination with Fentanyl During Phacoemulsification Cataract Surgery: A Double-Blind, Randomized, Controlled, Clinical Trial

Intravenous Midazolam as More Effective Than Propofol for Preventing Pruritus After Intrathecal Sufentanil in Surgical Patients: A Randomized Blinded Trial

Acil Serviste Omuz Çıkıklarının Değerlendirilmesi: Sedoanaljezi ve İzlem

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