Comparison of procedural sedation for the reduction of dislocated total hip arthroplasty.
BACKGROUND
Various types of sedation can be used for the reduction of a dislocated total hip arthroplasty. Traditionally, an opiate/benzodiazepine combination has been employed. The use of other pharmacologic agents, such as etomidate and propofol, have more recently gained popularity. Currently no studies directly comparing these sedation agents have been carried out. The purpose of this study is to compare differences in reduction and sedation outcomes, including recovery times, of these 3 sedation agents.


METHODS
We performed a retrospective chart review examining 198 patients who presented with dislocated total hip arthroplasty at 2 academic affiliated medical centers. The patients were grouped according to the type of sedation agent. We calculated percentages of reduction and sedation complications along with recovery times. Reduction complications included fracture, skin or neurovascular injury, and failure of reduction requiring general anesthesia. Sedation complications included use of bag-valve mask and artificial airway, intubation, prolonged recovery, use of a reversal agent, and inability to achieve sedation. We then compared the data for each sedation agent.


RESULTS
We found reduction complications rates of 8.7% in the propofol, 24.7% in the etomidate, and 28.9% in the opiate/benzodiazepine groups. The propofol group was significantly different from the other 2agents (p ≤ 0.01). Sedation complications were found 7.3% of the time in the propofol , 11.7% in the etomidate , and 21.3% in the opiate/benzodiazepine group, (p=0.02 propofol vs. others) . Average recovery times were 25.2 minutes for propofol, 30.8 minutes for etomidate, and 44.4 minutes for opiate/benzodiazepine (p = 0.05 for propofol vs. other agents).


CONCLUSIONS
For reduction of dislocated total hip arthroplasty under procedural sedation, propofol appears to have fewer complications and a trend toward more rapid recovery than both etomidate and opiate/benzodiazepine. These data support the use of propofol as first line agent for procedural sedation of dislocated total hip arthroplasty, with fewer complications and a shorter recovery period.
Southern Illinois University School of Medicine, Department of Surgery, Division of Emergency Medicine, Springfield, Illinois.
Jonathan E
JE
Dela Cruz
Southern Illinois University School of Medicine, Department of Surgery, Division of Orthopaedics, Springfield, Illinois.
Donald N
DN
Sullivan
Southern Illinois University School of Medicine, Department of Surgery, Division of Orthopaedics, Springfield, Illinois.
Eric
E
Varboncouer
Southern Illinois University School of Medicine, Department of Surgery, Division of Emergency Medicine, Springfield, Illinois ; Southern Illinois University School of Medicine, Center for Clinical Research, Springfield, Illinois.
Joseph C
JC
Milbrandt
Southern Illinois University School of Medicine, Department of Surgery, Division of Emergency Medicine, Springfield, Illinois.
Myto
M
Duong
Southern Illinois University School of Medicine, Department of Surgery, Division of Emergency Medicine, Springfield, Illinois.
Scott
S
Burdette
Southern Illinois University School of Medicine, Department of Surgery, Division of Emergency Medicine, Springfield, Illinois.
Daniel
D
O'Keefe
Southern Illinois University School of Medicine, Center for Clinical Research, Springfield, Illinois.
Steven L
SL
Scaife
Southern Illinois University School of Medicine, Department of Surgery, Division of Orthopaedics, Springfield, Illinois.
Khaled J
KJ
Saleh
D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D005045:Etomidate / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006617:Hip Dislocation / Q000209:etiology* / Q000628:therapy; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D015742:Propofol / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies
D006993:Hypnotics and Sedatives; D015742:Propofol; D005045:Etomidate