Sedation for cardioversion in the emergency department

Coll-Vinent, Blanca; Sala, Xavier Pintó; Fernández, Carme; Bragulat, Ernest; Espinosa, Gerard; Miró, Òscar; Milla, José Javier Pérez; Sánchez, Miquel

doi:10.1016/s0196-0644(03)00510-9

Cited by 90 publications

(70 citation statements)

References 16 publications

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“…A sensitivity analysis was performed to assess the impact of individual studies and low-quality studies on the results of the meta-analysis. This was done by removing one RCT at a time from the Bag-mask valve ventilation Death < 93% 4 Use of an oral airway Disability < 92% 2,20 Transient apnea Hospital admission < 90% 3,5,6,12,15,[22][23][24]29,33,34,[40][41][42][43] Vomiting without aspiration Prolonged ED stay Transient hypotension Intubation Myoclonus…”

Section: Study Protocolmentioning

confidence: 99%

“…1,3,4 Ketamine, etomidate, ketafol, and methohexital are used less commonly in adults, and ketamine and etomidate are associated with minor yet bothersome side effects (emergence and myoclonus, respectively), which may limit their widespread use in this patient population. 2,[5][6][7][8][9] Cohort studies, registry data, and small randomized controlled trials (RCTs) suggest that propofol and midazolam are safe and effective for use in PS. However, only few comparative studies have been conducted, and it remains unclear whether one agent is superior with regard to safety and clinical effectiveness endpoints.…”

mentioning

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: Study Protocolmentioning

confidence: 99%

mentioning

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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“…3,6,7 The use of propofol, ketamine and etomidate have become commonplace in the ED as a result. 2,[8][9][10][11][12][13] The literature has supported this change for patients of all ages, [12][13][14] and even for those with significant pre-existing disease. 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.…”

Section: Introductionmentioning

confidence: 97%

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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“…Sedasyon dozunun ve seviyesinin ayarlanmsı önemli-dir. Yetersiz sedasyon işlemin farkındalığını artırmak-ta, sempatik aktivite artışı özellikle yaşlı hastalarda tehlikeli ritm bozukluklarına neden olabilmektedir [25][26][27] . Genel anestezi veya sedasyonun derinliğini BIS monitorizasyonu ile değerlendirilebilir [28][29][30] .…”

Section: Kronik Atriyal Fibrilasyonu Olan Hastalarin Kardiyoversiyon unclassified

Anesteziyolog Bakış Açısından Atriyal Fibrilasyon

Kabukçu¹,

Şahin²,

Titiz³

2017

GKDA Derg

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ÖZ GiRiŞAtriyal fibrilasyon (AF) en sık görülen kardiyak aritmidir, atriyal miyositlerdeki elektiriksel aktivitenin bozukluğu ile oluşur. AF serebral tromboemboli zemininde inme ve diğer tromboembolik olaylar, sol ventrikül fonksiyon bozukluğu, kalp yetmezliği gibi mortaliteyi artıran ciddi komplikasyonlar ile birliktedir. Ayrıca hastaneye yatış oranında artma, yaşam kalitesinin bozulması ve egzersiz kapasitesinin azalması gibi nedenlerle morbiditeyi etkilemektedir [1] . AF genel popülasyonun %1-2'sinde ve görülme sıklığı 40-50 yaş aralığındadır. Yaşla birlikte artmakta ve 80 yaşında % 5-15 oranına ulaşmaktadır [2][3][4][5][6] . Erkekler kadınlardan daha fazla etkilenmektedir [7] .EKG'de P dalgalarının yokluğu ve düzensiz RR aralı-ğı saptanması ile AF tanısı konur. Aritminin başlangıç ve seyrine göre paroksismal, ısrarcı ve kalıcı olmak üzere üç sekilde sınıflandırılır. Paroksismal AF 48 saat içinde genellikle kendiliğinden düzelir. Israrcı AF 1 haftadan 1 yıla kadar sürebilir, kendiliğinden düzelmez medikal veya doğru akım (DC) kardiyoversiyon ile sinüs ritmine döndürülebilir (Tablo 1). Kalıcı AF'de medikal veya kardiyoversiyon ile sinüs ritmine dönüş olası olmaz [1,8,9] . AF tanısı EKG ile kolaylıkla konmasına rağmen, birçok hastada asemptomatiktir. Komplikasyonlar gelişene kadar tanı konamayabilir. AF nedeni kardiyovasküler veya değildir. Örneğin, geçirilmiş miyokard infarktüsü, kardiyomiyopati, hipertansiyon, kapak hastalıkları ve kalp yetmezliği kardiyovasküler nedenlerdir. Diyabet, obezite, alkol, hipertiroidi, KOAH ve diğer metabolik bozukluklar ise diğer AF nedenleridir [8,10] .Preoperatif AF tanısı alan hastada anestezist, semptomları hafifletme, hemodinamik stabiliteyi devam ettirme ve kardiyopulmoner komplikasyonları önle-meye odaklanmalıdır. Cerrah ile birlikte anestezist, cerrahiye devam kararına varmadan önce kalp açısın-dan temel laboratuvar ve görüntüleme tetkiklerinin gerekliliğine karar vermelidir [1,11] .

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Sedation for cardioversion in the emergency department

Cited by 90 publications

References 16 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

Anesteziyolog Bakış Açısından Atriyal Fibrilasyon

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