The use of propofol for procedural sedation in emergency departments

Wakai, Abel; Blackburn, Carol; McCabe, Aileen; Reece, Emilia; O'Connor, Gerard; Glasheen, John; Staunton, Paul; Cronin, John J.; Sampson, Christopher; McCoy, S; O’Sullivan, Ronan; Cummins, Fergal

doi:10.1002/14651858.cd007399.pub2

Cited by 15 publications

(6 citation statements)

References 26 publications

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“…From 2,882 unique references, 14 completed systematic reviews were included (Figure , Table ). Three protocols for in‐process reviews were identified on propofol and midazolam for procedural sedation and structured sedation programs in acute care settings; since the protocols provide no data they are not included in this review. The number of primary studies across all reviews was 435; however, not all studies were relevant to our topic (e.g., some included both pediatric and adult populations or settings other than the ED).…”

Section: Resultsmentioning

confidence: 99%

What Works and What's Safe in Pediatric Emergency Procedural Sedation: An Overview of Reviews

Hartling

Milne

Foisy

et al. 2016

Academic Emergency Medicine

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BackgroundSedation is increasingly used to facilitate procedures on children in emergency departments (EDs). This overview of systematic reviews (SRs) examines the safety and efficacy of sedative agents commonly used for procedural sedation in children in the ED or similar settings.MethodsWe followed standard SR methods: comprehensive search; dual study selection, quality assessment, data extraction. We included SRs of children (1 month to 18 years) where the indication for sedation was procedure‐related and performed in the ED.ResultsFourteen SRs were included (210 primary studies). The most data were available for propofol (six reviews/50,472 sedations) followed by ketamine (7/8,238), nitrous oxide (5/8,220), and midazolam (4/4,978). Inconsistent conclusions for propofol were reported across six reviews. Half concluded that propofol was sufficiently safe; three reviews noted a higher occurrence of adverse events, particularly respiratory depression (upper estimate 1.1%; 5.4% for hypotension requiring intervention). Efficacy of propofol was considered in four reviews and found adequate in three. Five reviews found ketamine to be efficacious and seven reviews showed it to be safe. All five reviews of nitrous oxide concluded it is safe (0.1% incidence of respiratory events); most found it effective in cooperative children. Four reviews of midazolam made varying recommendations. To be effective, midazolam should be combined with another agent that increases the risk of adverse events (upper estimate 9.1% for desaturation, 0.1% for hypotension requiring intervention).ConclusionsThis comprehensive examination of an extensive body of literature shows consistent safety and efficacy for nitrous oxide and ketamine, with very rare significant adverse events for propofol. There was considerable heterogeneity in outcomes and reporting across studies and previous reviews. Standardized outcome sets and reporting should be encouraged to facilitate evidence‐based recommendations for care.

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Section: Resultsmentioning

confidence: 99%

What Works and What's Safe in Pediatric Emergency Procedural Sedation: An Overview of Reviews

Hartling

Milne

Foisy

et al. 2016

Academic Emergency Medicine

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“…149 Some upcoming evidence exists on intranasal drug administration during PSA, for example for dexmedetomidine. 155 Propofol remains the most common sedative drug, [156][157][158][159][160][161][162] mainly for its short onset time (30 to 60 s), predictable duration of action and short context-sensitive half-time. It induces a dose-dependent amnesia and sedation, leading to unconsciousness and general anaesthesia at higher concentrations.…”

Section: H Location and Environment For Procedural Sedation And Analg...mentioning

confidence: 99%

European Society of Anaesthesiology and European Board of Anaesthesiology guidelines for procedural sedation and analgesia in adults

Hinkelbein

Lamperti

Åkeson

et al. 2018

European Journal of Anaesthesiology

213

211

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: Procedural sedation and analgesia (PSA) has become a widespread practice given the increasing demand to relieve anxiety, discomfort and pain during invasive diagnostic and therapeutic procedures. The role of, and credentialing required by, anaesthesiologists and practitioners performing PSA has been debated for years in different guidelines. For this reason, the European Society of Anaesthesiology (ESA) and the European Board of Anaesthesiology have created a taskforce of experts that has been assigned to create an evidence-based guideline and, whenever the evidence was weak, a consensus amongst experts on: the evaluation of adult patients undergoing PSA, the role and competences required for the clinicians to safely perform PSA, the commonly used drugs for PSA, the adverse events that PSA can lead to, the minimum monitoring requirements and post-procedure discharge criteria. A search of the literature from 2003 to 2016 was performed by a professional librarian and the retrieved articles were analysed to allow a critical appraisal according to the Grading of Recommendations Assessment, Development and Evaluation method. The Taskforce selected 2248 articles. Where there was insufficiently clear and concordant evidence on a topic, the Rand Appropriateness Method with three rounds of Delphi voting was used to obtain the highest level of consensus among the taskforce experts.These guidelines contain recommendations on PSA in the adult population. It does not address sedation performed in the ICU or in children and it does not aim to provide a legal statement on how PSA should be performed and by whom. The National Societies of Anaesthesiology and Ministries of Health should use this evidence-based document to help decision-making on how PSA should be performed in their countries. The final draft of the document was available to ESA members via the website for 4 weeks with the facility for them to upload their comments. Comments and suggestions of individual members and national Societies were considered and the guidelines were amended accordingly. The ESA guidelines Committee and ESA board finally approved and ratified it before publication.

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“…However, insufficient information was available regarding the total number of anesthetized patients, thus it was impossible to evaluate the incidence of these side effects. In 2015, a Cochrane systematic review of sedation administered in emergency departments was unable to draw a conclusion regarding the effectiveness and safety of the different types of existing sedation due to the low number of sufficient quality clinical trials available [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Monitored Anesthesia Care Involving Sedation and Axillary Nerve Block for Day-Case Hand Surgery

Sanchez

Chrusciel

Cimino³

et al. 2022

Healthcare

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Background: Ultrasound-guided axillary brachial plexus block (ABPB) is a technique of choice for regional anesthesia during hand and forearm surgery. Intravenous sedation may facilitate this procedure, particularly for those suffering from anxiety; however, it can also be associated with respiratory, cardiovascular, and neurological side effects. The objective of this study was to evaluate the effect of intravenous sedation on perioperative respiratory depression for patients undergoing day-case hand surgery under ABPB. Methods: A prospective, observational, single-center study was conducted between 1 May and 1 November 2016. Results: A total of 2318 patients were included, with 501 patients in the group with IV sedation and 1817 in the group without. A multivariable propensity-score matched analysis showed that the variables associated with the number of desaturation were: (i) sedation (aRR 1.534 [95% CI: 1.283 to 1.836]), (ii) age and sex, (iii) type of surgery, and iv) Body Mass Index (BMI). Conclusions: Supplementing ABPB with IV sedation was associated with an increased rate of respiratory depression (episodes of desaturation) compared to fully awakened patients. The rate of oxygen administration was also higher in sedated patients even though they had fewer cases of chronic respiratory diseases and fewer were active smokers than non-sedated patients. Future research should consider precisely evaluating patient satisfaction, as well as the differences between sedation and drug-free approaches.

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The use of propofol for procedural sedation in emergency departments

Cited by 15 publications

References 26 publications

What Works and What's Safe in Pediatric Emergency Procedural Sedation: An Overview of Reviews

What Works and What's Safe in Pediatric Emergency Procedural Sedation: An Overview of Reviews

European Society of Anaesthesiology and European Board of Anaesthesiology guidelines for procedural sedation and analgesia in adults

Evaluation of Monitored Anesthesia Care Involving Sedation and Axillary Nerve Block for Day-Case Hand Surgery

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