The use of propofol for procedural sedation and analgesia in the emergency department: a comparison with midazolam

Rahman, Nik Hisamuddin Nik Ab; Hashim, Ahmad

doi:10.1136/emj.2009.085019

Cited by 19 publications

(12 citation statements)

References 22 publications

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“…5,6,9 –41 The most common indications for procedural sedation were orthopedic manipulation, abscess incision and drainage, and direct current cardioversion. Most trials included patients with a mean or median age of approximately 20-57 years, 9,10,12 –17,19 –22,24 –26,28,31 –34,37 –41 weight of approximately 60-85 kg, 10,12 –15,19,20,22,34,37,41 and American Society of Anesthesiologists classification 1 or 2 (defined as patient is completely healthy and fit or patient has mild systemic disease). 11 …”

Section: Data Synthesismentioning

confidence: 99%

“…Most trials included patients with a mean or median age of approximately 20-57 years, 9,10,12 –17,19 –22,24 –26,28,31 –34,37 –41 weight of approximately 60-85 kg, 10,12 –15,19,20,22,34,37,41 and American Society of Anesthesiologists classification 1 or 2 (defined as patient is completely healthy and fit or patient has mild systemic disease). 11 –17,19 –21,28,30 Details on specific groups of participants who were included and excluded in each study can be found in Tables 1 and 2. Total doses of propofol ranged from 0.75 to 1.86 mg/kg, 10 –15,21,22,25,26,31 –36,40,41 with the most common dosing regimen being a 1.0-mg/kg bolus followed by 0.5 mg/kg every 3 minutes as needed for additional sedation.…”

Section: Data Synthesismentioning

confidence: 99%

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Propofol for Procedural Sedation in the Emergency Department: A Qualitative Systematic Review

Black

Campbell

Magee³

et al. 2013

Ann Pharmacother

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Section: Data Synthesismentioning

confidence: 99%

Section: Data Synthesismentioning

confidence: 99%

Propofol for Procedural Sedation in the Emergency Department: A Qualitative Systematic Review

Black

Campbell

Magee³

et al. 2013

Ann Pharmacother

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show abstract

“…We also evaluated patient opinion of the procedure to assess for tolerability of the interventions. To validate the above models, we reported the P value of the Le Cessie-van Houwelingen test, [14,15] and assessed for the effect of collinearity using the variance inflation factors (VIFs). A VIF of greater than five was considered a priori an unacceptable level of dependency between the candidate predictors.…”

Section: Methodsmentioning

confidence: 99%

Emergency department procedural sedation for primary electrical cardioversion — a comparison with procedural sedations for other reasons

Butler

Froese

Zed

et al. 2017

World Journal of Emergency Medicine

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BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia treated in the emergency department (ED), with primary electrical cardioversion (PEC) the preferred method of rhythm control. Anecdotally, patients undergoing ED procedural sedation (EDPS) for PEC differ from those requiring EDPS for other procedures: they are at higher risk of adverse events, and require fewer drugs and lower doses. We attempt to verify this using an EDPS registry at a Canadian, tertiary care teaching hospital.METHODS: This is a retrospective review of patients that underwent EDPS for the period of June 2006 to September 2014. We compared demographics, medication use and intra-procedural adverse events between those receiving EDPS for PEC for AF compared to that for other indications. We report the asssociation between AEs and predictors using logistic regression.RESULTS: A total of 4 867 patients were included, 714 for PEC for AF and 4 153 for other indications. PEC patients were more likely male (58.5% vs. 47.1%), older (59.5 years vs. 48.1 years), and less likely to be ASA I (46.6% vs. 69.0%). PEC patients received smaller doses of propofol and less likely to receive adjuvant analgesic therapy (11.5% vs. 78.2%). PEC patients were more likely to experience hypotension (27.6% vs. 16.5%) but respiratory AEs (apnea, hypoxia and airway intervention) were not different.CONCLUSION: EDPS for PEC differs from that conducted for other purposes: patients tend to be less healthy, receive smaller doses of medication and more likely to suffer hypotension without an increase in respiratory AEs. These factors should be considered when performing EDPS.

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“…However, further studies are needed in order to evaluate the antinociceptive effect of ayahuasca in the presence and absence of antagonists to better elucidate its mechanism of action. Ayahuasca interactions with propofol in the antinociceptive tests were not evaluated because the analgesic effect after propofol acute administration is too short (Anwar, Abdel-Rahman, 1998;Rahman, Hashim, 2011).…”

Section: Treatment and Doses (Mg/kg)mentioning

confidence: 99%

Pre-clinical interaction of ayahuasca, a brew used in spiritual movements, with morphine and propofol

Pires

Mendes

Pires

et al. 2018

Braz. J. Pharm. Sci.

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Ayahuasca is a beverage with psychoactive properties used in religious and ceremonial rituals by some religious groups. The main active components of ayahuasca are dimethyltryptamine and the harmala alkaloids with β-carboline structure acting as monoamine oxidase A inhibitors. This combination produces a pronounced activation of serotonergic pathways and presents potential interaction with other psychotropics. The objective of this study was to investigate the possible interactions between ayahuasca and agents employed in general anesthesia. The pharmacological interactions between ayahuasca and morphine or propofol were evaluated in mice using doses of 12, 120 and 1200 mg/kg (0.1 to 10 times the average dose consumed by humans in religious rituals). Ayahuasca alone showed an antinociceptive effect in the writhing and formalin tests, and intensified the analgesic effect of morphine in the hot plate test. Concerning the pharmacological interactions between ayahuasca and propofol, the results were opposite; ayahuasca intensified the depressant effect of propofol in the rotarod test, but decreased the sleeping time induced by propofol. These set of results showed the occurrence of some interactions between ayahuasca and the drugs morphine and propofol, possibly by both pharmacokinetics and pharmacodynamics mechanisms.

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The use of propofol for procedural sedation and analgesia in the emergency department: a comparison with midazolam

Abstract: Both propofol and midazolam given at the recommended doses were equally safe and effective for PSA in the ED. The propofol group was discharged much earlier than to the midazolam group.

Cited by 19 publications

References 22 publications

Propofol for Procedural Sedation in the Emergency Department: A Qualitative Systematic Review

Propofol for Procedural Sedation in the Emergency Department: A Qualitative Systematic Review

Emergency department procedural sedation for primary electrical cardioversion — a comparison with procedural sedations for other reasons

Pre-clinical interaction of ayahuasca, a brew used in spiritual movements, with morphine and propofol

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