title: Does the sedation regimen affect adverse events during procedural sedation and analgesia in injection drug users?
abstract: OBJECTIVE
  Injection drug users (IDUs) often undergo procedural sedation and analgesia (PSA) as part of emergency department (ED) treatment. We compared adverse events (AEs) using a variety of sedation regimens.
  
  
  METHODS
  This was a retrospective analysis of a PSA safety audit in two urban EDs. Consecutive self-reported IDUs were identified, and structured data describing comorbidities, vital signs, sedation regimens (propofol [P], propofol-fentanyl [PF], fentanyl-midazolam [FM], ketofol [1:1 ketamine:propofol, KF], and ketamine-propofol [KP]) and AEs were collected. The primary outcome was the proportion of patients in each sedation group having an AE; the secondary outcome was the proportion of patients having a cardiovascular or respiratory AE.
  
  
  RESULTS
  Data were collected on 276 IDUs (78 P, 82 PF, 65 FM, 25 KF, and 26 KP), and 18 patients had AEs (6.5%, 95% CI 4.0-10.3). The AE rates were 0.0%, 8.5%, 9.2%, 12.0%, and 7.6%, respectively, with propofol having a significantly lower rate (Pearson coefficient 14.9, p  =  0.007). The cardiovascular/respiratory AE rates were significantly different as well, with P, KP, and KF having the lowest rates (Pearson coefficient 13.3, p  =  0.01).
  
  
  CONCLUSIONS
  For IDU PSA, the overall AE rate was 6.5%, and propofol appeared to have a significantly lower rate.
authors: Frank
authors: F
authors: Xavier Scheuermeyer
authors: Gary
authors: G
authors: Andolfatto
authors: Hong
authors: H
authors: Qian
authors: Eric
authors: E
authors: Grafstein
mesh_terms: D000328:Adult; D000698:Analgesia / Q000009:adverse effects*; D016292:Procedural Sedation / Q000379:methods*; D055030:Drug Users; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors