Safety and clinical effectiveness of midazolam versus propofol for procedural sedation in the emergency department: a systematic review.
OBJECTIVE
To synthesize the evidence comparing the adverse event (AE) profile and clinical effectiveness of midazolam and propofol for procedural sedation (PS) in adults in the emergency care setting.


METHODS
The authors conducted a systematic review of randomized controlled trials (RCTs) and observational studies reporting the use of either midazolam and/or propofol for adult PS in the emergency department (ED). A systematic search strategy was developed and applied to six bibliographic reference databases. Three emergency medicine journals, the Canadian Adverse Drug Reaction Newsletter, and conference proceedings were hand-searched. Retrieved articles were reviewed and data were abstracted using standardized data collection. Trial quality was assessed using the Jadad score. The outcomes assessed were the proportion of patients with AEs and the pooled mean difference in the proportion of patients with successful PS.


RESULTS
Of 229 articles identified, 28 met the inclusion criteria for the analysis of AEs. Only one major AE to PS was found, resulting in no statistically significant difference in the proportion of major AEs between agents. Four studies were RCTs that met the inclusion criteria for the analysis of clinical effectiveness. Two trials met criteria for good quality. The RCTs enrolled between 32 and 86 patients, and the most common indications for PS were orthopedic reductions and cardioversions. There was a nonsignificant difference in the proportion of patients with successful PS in favor of propofol (effect difference 2.9%, 95% confidence interval (CI) = -6.5 to 15.2).


CONCLUSIONS
The authors found no significant difference in the safety profile and the proportion of successful PS between midazolam and propofol for adults in the ED.
Hohl
Corinne Michèle
CM
Division of Emergency Medicine, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada. corinnehohl@yahoo.ca
Sadatsafavi
Mohsen
M
Nosyk
Bohdan
B
Anis
Aslam Hayat
AH
D000328:Adult; D016292:Procedural Sedation / Q000295:instrumentation*; D004632:Emergency Medical Services / Q000379:methods*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008874:Midazolam / Q000627:therapeutic use*; D010043:Outcome and Process Assessment, Health Care; D015742:Propofol / Q000627:therapeutic use*; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives; D008874:Midazolam; D015742:Propofol