title: Propofol for procedural sedation in the emergency department: a qualitative systematic review.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of propofol compared to other agents for procedural sedation of adults in the emergency department (ED) and to review the use of opioids in conjunction with propofol for procedural sedation in the ED.
  
  
  METHODS
  PubMed (1949-December 2012) and EMBASE (1980-December 2012) were searched using combinations of the following search terms: (procedural sedation or conscious sedation [MESH]) and propofol. A manual search of references was also performed.
  
  
  METHODS
  English-language, full reports of randomized controlled trials (RCTs) and observational studies evaluating propofol use in adults undergoing procedural sedation in the ED were included if they reported efficacy or safety outcomes. Two reviewers independently assessed each article for inclusion, data extraction, and study limitations.
  
  
  RESULTS
  Thirteen RCTs and 20 observational studies meeting our inclusion criteria were retrieved. Regardless of the agent used for sedation, pro ce du ral success was greater than 80% and most trials demonstrated no statistically significant difference in the incidence of respiratory depression with propofol compared to alternatives. One RCT showed a significantly greater percent decrease in systolic blood pressure from baseline in those who received propofol compared to ketamine. Where reported, no significant difference was found in patient recall, pain, and satisfaction when opioids were added to propofol com pared to propofol alone; the addition of opioids may have resulted in a higher incidence of respiratory adverse events.
  
  
  CONCLUSIONS
  Propofol for procedural sedation is a reasonable alternative for use in the ED, with comparative efficacy and safety to other alternatives. Use of opioids in addition to propofol may not provide added benefit but does contribute to increased rates of adverse events.
authors.affiliation: College of Pharmacy, Qatar University, Doha, Qatar.
authors.forename: Emily
authors.initials: E
authors.lastname: Black
authors.forename: Samuel G
authors.initials: SG
authors.lastname: Campbell
authors.forename: Kirk
authors.initials: K
authors.lastname: Magee
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Zed
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use; D016292:Procedural Sedation / Q000379:methods* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007649:Ketamine / Q000627:therapeutic use; D015742:Propofol / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D007649:Ketamine; D015742:Propofol