title: Profiling adverse respiratory events and vomiting when using propofol for emergency department procedural sedation.
abstract: OBJECTIVE
  To evaluate the rate of adverse respiratory events and vomiting among ED patients undergoing procedural sedation with propofol.
  
  
  METHODS
  This was a prospective, observational series of patients undergoing procedural sedation. Titrated i.v. propofol was administered via protocol. Fasting status was recorded.
  
  
  RESULTS
  Four hundred patients undergoing sedation were enrolled. Of these 282 (70%, 95% confidence interval [CI] 66-75%) had eaten or drunken within 6 and 2 h, respectively. Median fasting times from a full meal, snack or drink were 7 h (interquartile range [IQR] 5-9 h), 6 h (IQR 4-8 h) and 4 h (IQR 2-6 h), respectively. Overall a respiratory event occurred in 86 patients (22%, 95% CI 18-26%). An airway intervention occurred in 123 patients (31%, 95% CI 26-35%). In 111 cases (90%, 95% CI 60-98%) basic airway manoeuvres were all that was required. No patients were intubated. Two patients vomited (0.5%, 95% CI 0.0-1.6%), one during sedation, one after patient became conversational. One patient developed transient laryngospasm (0.25%, 95% CI 0-1.2%) unrelated to vomiting. There were nil aspiration events (0%, 95% CI 0-0.74%).
  
  
  CONCLUSIONS
  Seventy per cent of patients undergoing ED procedural sedation are not fasted. No patient had a clinically evident adverse outcome. Transient respiratory events occur but can be managed with basic airway interventions making propofol a safe alternative for emergency physicians to provide emergent procedural sedation.
authors.affiliation: Department of Emergency Medicine, Redcliffe Hospital, Redcliffe, Queensland, Australia. anthony_bell@health.qld.gov.au
authors.forename: Anthony
authors.initials: A
authors.lastname: Bell
authors.forename: Greg
authors.initials: G
authors.lastname: Treston
authors.forename: Charley
authors.initials: C
authors.lastname: McNabb
authors.forename: Kathy
authors.initials: K
authors.lastname: Monypenny
authors.forename: Robert
authors.initials: R
authors.lastname: Cardwell
mesh_terms: D000293:Adolescent; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000009:adverse effects* / Q000627:therapeutic use; D011446:Prospective Studies; D012129:Respiratory Function Tests; D012140:Respiratory Tract Diseases / Q000139:chemically induced*; D012307:Risk Factors; D013997:Time Factors; D014839:Vomiting / Q000139:chemically induced*
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol