title: Propofol for procedural sedation and analgesia reduced dedicated emergency nursing time while maintaining safety in a community emergency department.
abstract: BACKGROUND
  Procedural sedation and analgesia is a core competency in emergency medicine. Propofol is replacing midazolam in many emergency departments. Barriers to performing procedural sedation include resource utilization. We hypothesized that emergency nursing time is shorter with propofol than midazolam, without increasing complications.
  
  
  METHODS
  Retrospective analysis of a procedural sedation registry for two community emergency departments with combined census of 100,000 patients/year. Demographics, procedure, and ASA physical classification status of adult patients receiving procedural sedation between 2007-2010 with midazolam or propofol were analyzed. Primary outcome was dedicated emergency nursing time. Secondary outcomes were procedural success, ED length of stay, and complication rate. Comparative statistics were performed with Mann-Whitney, Kruskal-Wallis, chi-square, or Fisher's exact test. Linear regression was performed with log-transformed procedural sedation time to define predictors.
  
  
  RESULTS
  Of 328 procedural sedation and analgesia, 316 met inclusion criteria, of which 60 received midazolam and 256 propofol. Sex distribution varied between groups (midazolam 3% male; propofol 55% male; P = 0.04). Age, procedure, and ASA status were not significantly different. Propofol had shorter procedural sedation time (propofol 32.5 ± 24.2 minutes; midazolam 78.7 ± 51.5 minutes; P < 0.001) and higher rates of procedural success (propofol 98%; midazolam 92%; P = 0.02). There were no significant differences between complication rates (propofol 14%; midazolam 13%; P = 0.88) or emergency department length of stay (propofol 262.5 ± 132.8 minutes; midazolam 288.6 ± 130.6 minutes; P = 0.09).
  
  
  CONCLUSIONS
  Use of propofol resulted in shorter emergency nursing time and higher procedural success rate than midazolam with a comparable safety profile.
authors: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA. reynoldsjc@upmc.edu
authors: Joshua C
authors: JC
authors: Reynolds
authors: Michael K
authors: MK
authors: Abraham
authors: Fermin F
authors: FF
authors: Barrueto
authors: Daniel L
authors: DL
authors: Lemkin
authors: Jon M
authors: JM
authors: Hirshon
mesh_terms: D016529:Emergency Nursing / Q000379:methods* / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D008297:Male; D008874:Midazolam; D008875:Middle Aged; D061214:Patient Safety / Q000706:statistics & numerical data*; D015742:Propofol; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam; D015742:Propofol
keywords: Emergency medicine; Midazolam; Procedural sedation and analgesia; Propofol