Profiling adverse respiratory events and vomiting when using propofol for emergency department procedural sedation.
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.
Bell
Anthony
A
Department of Emergency Medicine, Redcliffe Hospital, Redcliffe, Queensland, Australia. anthony_bell@health.qld.gov.au
Treston
Greg
G
McNabb
Charley
C
Monypenny
Kathy
K
Cardwell
Robert
R
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*
D006993:Hypnotics and Sedatives; D015742:Propofol