A randomized controlled trial comparing patient-controlled and physician-controlled sedation in the emergency department.
OBJECTIVE
We compare patient-controlled sedation (PCS) and emergency physician-controlled sedation (EPCS) with respect to propofol requirements, depth of sedation, adverse events, recovery time, physician satisfaction, and patient satisfaction in emergency department (ED) patients requiring brief but painful procedures.


METHODS
One hundred sixty-six patients in this randomized controlled trial received propofol sedation according to one of 2 regimens: infusion of propofol at doses determined by the treating physician (EPCS group) or infusion of propofol with a patient-controlled infusion pump (PCS group). The PCS group received an initial physician-controlled bolus following by self-administered doses. Depth of sedation was assessed at 3-minute intervals. Adverse events were recorded as they occurred. Physician and patient satisfaction were recorded with 100-mm visual analog scales.


RESULTS
There was a nonsignificant trend toward lower total propofol doses with PCS relative to EPCS (medians 1.36 versus 1.60 mg/kg, respectively; median difference -0.15 mg/kg; 95% confidence interval of the difference -0.33 to 0.05 mg/kg; P=.14). Adverse events, requirement for treatment of adverse events, and recovery time did not differ in the 2 groups. Depth of sedation was lower in the PCS group. Procedural success, ease of procedure, and patient satisfaction were similar in both groups despite nearly twice as many patients recalling the procedure in the PCS group and 15% of patients requiring additional physician-administered doses in the PCS group.


CONCLUSIONS
Compared with EPCS, PCS demonstrated similar propofol dosing, safety, recovery, and satisfaction but resulted in lighter sedation. Propofol PCS appears safe and effective for ED procedures requiring moderate rather than deep sedation.
Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. anthony_bell@health.qld.gov.au
Anthony
A
Bell
Trent
T
Lipp
Jaimi
J
Greenslade
Kevin
K
Chu
Sean
S
Rothwell
Alison
A
Duncan
D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000379:methods; D018686:Anesthetics, Intravenous / Q000009:adverse effects* / Q000627:therapeutic use; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007260:Infusion Pumps; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D017060:Patient Satisfaction; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D013997:Time Factors; D055815:Young Adult
D018686:Anesthetics, Intravenous; D015742:Propofol