Propofol for procedural sedation in children in the emergency department.
OBJECTIVE
We determine the safety and efficacy of propofol sedation for painful procedures in the emergency department (ED).


METHODS
A consecutive case series of propofol sedations for painful procedures in the ED of a tertiary care pediatric hospital from July 2000 to July 2002 was performed. 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. Adverse events were documented, as were the sedation duration, recovery time from sedation, and total time in the ED.


RESULTS
Three hundred ninety-three discrete sedation events with propofol were analyzed. Procedures consisted of the following: fracture reductions (94%), reduction of joint dislocations (4%), spica cast placement (2%), and ocular examination after an ocular burn (0.3%). The median propofol dose was 2.7 mg/kg. Ninety-two percent of patients had a transient (<or=2 minutes) decrease in systolic blood pressure without clinical signs of poor perfusion. Nineteen (5%) patients had hypoxia, 11 (3%) patients required airway repositioning or jaw-thrust maneuvers, and 3 (0.8%) patients required bag-valve-mask ventilation. No patient required endotracheal intubation.


CONCLUSIONS
Propofol sedation is efficacious and can be used safely in the ED setting under the guidance of a protocol. Transient cardiopulmonary depression occurs, which requires vigilant monitoring by highly skilled practitioners. Propofol is well suited for short, painful procedures in the ED setting.
Bassett
Kathlene E
KE
Division of Pediatric Emergency Medicine, Primary Children's Medical Center, University of Utah School of Medicine, Salt Lake City 84102, USA. kathlene.bassett@hsc.utah.edu
Anderson
Jana L
JL
Pribble
Charles G
CG
Guenther
Elisabeth
E
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage; D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D019162:Anesthetics, Combined; D001919:Bradycardia / Q000139:chemically induced; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D004632:Emergency Medical Services / Q000379:methods*; D005215:Fasting; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects; D005592:Fracture Fixation / Q000379:methods; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D007022:Hypotension / Q000139:chemically induced; D000860:Hypoxia / Q000139:chemically induced; D007223:Infant; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects; D010372:Pediatrics / Q000379:methods*; D015742:Propofol / Q000009:adverse effects; D011446:Prospective Studies; D012119:Respiration / Q000187:drug effects
D000759:Adjuvants, Anesthesia; D000701:Analgesics, Opioid; D019162:Anesthetics, Combined; D006993:Hypnotics and Sedatives; D009020:Morphine; D005283:Fentanyl; D015742:Propofol