title: Safety and efficacy of procedural sedation with propofol in a country with a young emergency medicine training program.
abstract: OBJECTIVE
  To evaluate the safety and effectiveness of procedural sedation with propofol by newly trained Dutch emergency physicians.
  
  
  METHODS
  A prospective observational cohort study of patients in emergency department undergoing procedural sedation at two teaching hospitals. Primary outcomes were serious adverse events, sedation events, and efficacy. A standardized protocol and data collection form was used at both sites.
  
  
  RESULTS
  Three hundred and eighty-six patients were enrolled over 18 months. The median age was 57 years (range 6-94, interquartile range 38-70), 55% were male patients. All had an American Society of Anesthesiologists class score of 3 or less. Indications for procedural sedation were reduction of dislocations (51%), electrocardioversion (32%), fracture reduction (8%), and abscess/wound treatment (6%). The median propofol dose was 1.0 mg/kg (0.70-1.5) and 45% received fentanyl in addition; median dose was 1 mcg/kg (0.6-1.3). Most had a Ramsay sedation score of 4 or 5. The procedural success rate was 99.5%. No serious adverse events were reported. Sedation events included; hypoventilation (11%), desaturation (5%), hypotension (3%), and bradycardia (1%), all of which resolved with simple supportive interventions. One patient vomited without aspirating. Increased age (>60 years) (P=0.001) and high Ramsay score (>3) (P=0.024) were the only significant predictors of events. Sex, weight, total dose of propofol, use of fentanyl, and type of procedure were not independent risk factors for any event.
  
  
  CONCLUSIONS
  Newly trained Dutch emergency physicians can perform procedural sedation with propofol safely and effectively. Increased age and high Ramsay scores were the only risk factors for sedation events. All events were minor and responded to simple interventions.
authors.affiliation: Department of Emergency Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. m.kuypers@westfriesgasthuis.nl
authors.forename: Maybritt I
authors.initials: MI
authors.lastname: Kuypers
authors.forename: Francis
authors.initials: F
authors.lastname: Mencl
authors.forename: Matthijs F
authors.initials: MF
authors.lastname: Verhagen
authors.forename: Maarten F
authors.initials: MF
authors.lastname: Kok
authors.forename: Lea M
authors.initials: LM
authors.lastname: Dijksman
authors.forename: Maarten P
authors.initials: MP
authors.lastname: Simons
mesh_terms: D000038:Abscess / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018686:Anesthetics, Intravenous / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D064420:Drug-Related Side Effects and Adverse Reactions; D004635:Emergency Medicine / Q000193:education*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D019990:Perioperative Care / Q000379:methods*; D015742:Propofol / Q000009:adverse effects* / Q000627:therapeutic use; D011446:Prospective Studies; D012307:Risk Factors; D013223:Statistics as Topic; D013997:Time Factors; D055815:Young Adult
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol