title: Efficacy, safety and patient satisfaction of propofol for procedural sedation and analgesia in the emergency department: a prospective study.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors: Department of Pharmacy and Pharmacotherapuetic Specialist-Emergency Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada. peter.zed@dal.ca
authors: Peter J
authors: PJ
authors: Zed
authors: Riyad B
authors: RB
authors: Abu-Laban
authors: Winnie W Y
authors: WW
authors: Chan
authors: David W
authors: DW
authors: Harrison
mesh_terms: D016292:Procedural Sedation; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007022:Hypotension / Q000139:chemically induced; D007262:Infusions, Intravenous / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010146:Pain / Q000209:etiology; D017060:Patient Satisfaction; D015742:Propofol / Q000627:therapeutic use*; D011446:Prospective Studies; D014839:Vomiting / Q000139:chemically induced
chemical_list: D006993:Hypnotics and Sedatives; D010100:Oxygen; D015742:Propofol