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Efficacy, safety and patient satisfaction of propofol for procedural sedation and analgesia in the emergency department: a prospective study

Published online by Cambridge University Press:  21 May 2015

Peter J. Zed ,
Riyad B. Abu-Laban ,
Winnie W.Y. Chan  and
David W. Harrison
Peter J. Zed*
Affiliation:
Department of Pharmacy and Pharmacotherapuetic Specialist–Emergency Medicine, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS College of Pharmacy and Department of Emergency Medicine, Dalhousie University, Halifax, NS Pharmacotherapeutic Specialist–Emergency Medicine, CSU Pharmaceutical Sciences, Vancouver General Hospital (VGH), University of British Columbia (UBC), Vancouver, BC Faculty of Pharmaceutical Sciences and Associate Member, Division of Emergency Medicine, University of British Columbia (UBC), Vancouver, BC
Riyad B. Abu-Laban
Affiliation:
Department of Emergency Medicine, VGH, UBC, Vancouver, BC Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, UBC, Vancouver, BC Michael Smith Foundation for Health Research, UBC, Vancouver, BC Division of Emergency Medicine, UBC, Vancouver, BC
Winnie W.Y. Chan
Affiliation:
CSU Pharmaceutical Sciences, VGH, Vancouver, BC
David W. Harrison
Affiliation:
Department of Emergency Medicine and Director, Hyperbaric Unit, VGH, UBC, Vancouver, BC Division of Emergency Medicine, UBC, Vancouver, BC
*
Queen Elizabeth II Health Sciences Centre, Department of Pharmacy – Halifax Infirmary, Rm. 2417, 1796 Summer St., Halifax NS B3H 3A7; peter.zed@dal.ca

Abstract

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Objective:

We evaluated the efficacy, safety and patient satisfaction with the use of propofol for procedural sedation and analgesia in the emergency department (ED).

Methods:

All patients receiving propofol for procedural sedation and analgesia in the ED between December 1, 2003, and November 30, 2005, were prospectively assessed. Propofol was administered using a standardized protocol, which included an initial dose of 0.25–0.5 mg/kg followed by 10–20 mg/minute until sedated. Efficacy was evaluated using procedural success rate, recovery time and physician satisfaction. Adverse respiratory effects were defined as apnea for more than 30 seconds or an oxygen saturation of less than 90%. Hypotension was defined as systolic blood pressure < 90 mm Hg or > 20% decrease from baseline. Patient and physician satisfaction were determined using 5-point Likert scales.

Results:

Our study included 113 patients with a mean age of 50 (standard deviation [SD] 19) years; 62% were male. The most common procedures were orthopedic manipulation (44%), cardioversion (37%), and abscess incision and drainage (13%). The mean total propofol dose required was 1.6 (SD 0.9) mg/kg. Procedural success was achieved in 90% of cases and the mean patient recovery time was 7.6 (SD 3.4) minutes. No patient (0%, 95% confidence interval [CI] 0%–3%) experienced apnea; however, 1 patient (1%, 95% CI 0%–5%) experienced emesis, which resulted in an oxygen saturation <90%. Nine patients (8%, 95% CI 4%–15%) experienced hypotension and 7 (6%, 95% CI 3%–12%) experienced pain on injection. All patients were very satisfied (92%, 95% CI 85%–96%) or satisfied (8%, 95% CI 4%–15%), and 94% (95% CI 88%–98%) reported no recollection of the procedure. The majority of physicians were very satisfied (85%, 95% CI 77%–91%) or satisfied (6%, 95% CI 3%–12%) with the sedation and the conditions achieved.

Conclusion:

When administered as part of a standardized protocol, propofol appears to be a safe and effective agent for performing procedural sedation and analgesia in the ED, and is associated with high patient and physician satisfaction.

Keywords

propofolprocedural sedationanalgesiaemergency department
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 9 , Issue 6 , November 2007 , pp. 421 - 427
Copyright
Copyright © Canadian Association of Emergency Physicians 2007

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