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Mastering Procedural Sedation in the Emergency Department

Onset/Duration: Onset of ~40 seconds, duration of ~5 min. Dose: 0.5 – 1 mg/kg loading dose followed by 0.5 mg/kg doses every 3-5 min or 20mg pushes every 1-2 mins PRN.

Pros: Short-acting sedative/amnestic, easy to redose, near immediate effect, decreased muscle tone for orthopedic procedures. Cons: No analgesia, has pain on injection, can cause hypotension and respiratory depression.

Special notes: Use a larger vein, such as in the antecubital fossa. Recommended to pretreat with opioid (fentanyl, typically 50-100mcg) or ketamine for procedural pain. The downside of opioid pretreatment is greater risk of respiratory depression. Injection pain can be reduced with intravenous…

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Articles of Interest

Clinical Practice Advisory: Emergency Department Procedural Sedation With Propofol

There are a number of compelling reasons for a propofol's specific clinical practice advisory. Unlike longer-acting agents such as fentanyl and midazolam, propofol is ultrashort acting and can induce rapid swings in consciousness. Accordingly, propofol requires special handling and attention relative to more traditional agents, which is of particular importance in that propofol is now arguably the most popular deep sedative in emergency medicine.

Deep Sedation With Propofol by Nonanesthesiologists

The need to perform procedural sedation for children has increased in recent years, and so has the experience of nonanesthesiologists in this field. The use of propofol increases the success of satisfactory deep sedation, but it can produce rapid and profound decreases in level of consciousness and cardiorespiratory function.

Emergency Department Procedural Sedation with Propofol: Is it Safe?

Propofol is a sedative agent gaining popularity for Emergency Department Procedural Sedation (EDPS). However, some institutions across the country continue to restrict the use of propofol secondary to safety concerns. The purpose of our study was to evaluate the complication rate of EDPS with propofol.

Ketofol vs Propofol for ED Procedural Sedation

The addition of ketamine may have a propofol sparing effect, but the combination "ketofol" is associated with more adverse effects when compared to propofol alone.

Propofol for adult procedural sedation in a UK emergency department: safety profile in 1008 cases

Our large series of propofol sedations performed by emergency physicians supports the safety of this practice. The sentinel adverse event rate of 1% that we identify prompts review: we will in future emphasize adherence to the reduced 0.5 mg kg−1 propofol dose in the elderly, and reconsider our use of metaraminol. We believe that our application of the World SIVA adverse event tool sets a benchmark for further studies.

Propofol for procedural sedation in children in the emergency department

A sedation protocol was followed. Propofol was administered in a bolus of 1 mg/kg, followed by additional doses of 0.5 mg/kg. Narcotics were administered 1 minute before propofol administration.

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

Propofol for procedural sedation is a reasonable alternative for use in the ED, with comparative efficacy and safety to other alternatives. Use of opioids in addition to propofol may not provide added benefit but does contribute to increased rates of adverse events.

The use of propofol for procedural sedation in emergency departments

We found very low quality evidence for the effects of propofol and the other drugs used for sedating people in the ED in terms of complications (side effects, including pain at the injection site) and participant satisfaction. In one study comparing a drug combination of propofol and fentanyl (a painkiller) with midazolam and ketamine (a drug which acts as both a painkiller and a sedative), delayed adverse reactions (nightmares and behavioural change) were noted in 10% of the ketamine/midazolam group and none in the propofol/fentanyl group.

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Life in the Fastlane

rapid offset (short context-sensitive half time) -> good for waking up quickly and neurologically +/- extubation.