title: Propofol versus midazolam for procedural sedation in the emergency department: A study on efficacy and safety.
abstract: BACKGROUND
  Procedural sedation for painful procedures in the emergency department (ED) can be accomplished with various pharmacological agents. The choice of the sedative used is highly dependent on procedure- and patient characteristics and on personal- or local preferences.
  
  
  METHODS
  We conducted a multicenter retrospective cohort study of procedural sedations performed in the EDs of 5 hospitals in the Netherlands over a 4year period to evaluate the efficacy- (success rate of the intended procedure) and safety (incidence of sedation (adverse) events) of propofol sedations compared to midazolam sedations.
  
  
  RESULTS
  A total of 592 ED sedations were included in our study. Patients sedated with propofol (n=284, median dose 75mg) achieved a deeper level of sedation (45% vs. 25% deep sedation, p<0.001), had a higher procedure success rate (92% vs. 81%, p<0.001) and shorter median sedation duration (10 vs. 17min, p<0.001) compared to patients receiving midazolam (n=308, median dose 4mg). A total of 112 sedation events were registered for 99 patients. Transient apnea was the most prevalent event (n=73), followed by oxygen desaturation (n=18) airway obstruction responsive to simple maneuvers (n=13) and hypotension (n=6). Propofol sedations were more often associated with the occurrence of apnea's (20% vs. 10%, p=0.004), whereas clinically relevant oxygen desaturations (<90%) were found more often in patients sedated with midazolam (8% vs. 1%, p=0.001). No sedation adverse events were registered CONCLUSION: Propofol is more effective and at least as safe as midazolam for procedural sedation in the ED.
authors.affiliation: Department of Emergency Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Heleen
authors.initials: H
authors.lastname: Lameijer
authors.affiliation: Department of Emergency Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
authors.forename: Ytje T
authors.initials: YT
authors.lastname: Sikkema
authors.affiliation: Department of Emergency Medicine, Wilhelmina Hospital, Assen, The Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: Pol
authors.affiliation: Department of Emergency Medicine, Nij Smellinghe Hospital, Drachten, The Netherlands.
authors.forename: Maike G E
authors.initials: MGE
authors.lastname: Bosch
authors.affiliation: Department of Emergency Medicine, Isala Klinieken, Zwolle, The Netherlands.
authors.forename: Femke
authors.initials: F
authors.lastname: Beije
authors.affiliation: Department of Emergency Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
authors.forename: Rieneke
authors.initials: R
authors.lastname: Feenstra
authors.affiliation: Department of Emergency Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Bas W J
authors.initials: BWJ
authors.lastname: Bens
authors.affiliation: Department of Emergency Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands. Electronic address: teravestewoud@hotmail.com.
authors.forename: Ewoud
authors.initials: E
authors.lastname: Ter Avest
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016292:Procedural Sedation; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008874:Midazolam / Q000627:therapeutic use*; D008875:Middle Aged; D009426:Netherlands; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement; D061214:Patient Safety; D015742:Propofol / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam; D015742:Propofol