The use of propofol for procedural sedation and analgesia in the emergency department: a comparison with midazolam.

INTRODUCTION: This study aimed to determine the effectiveness of propofol as an alternative agent for procedural sedation and analgesia (PSA) in the emergency department (ED) and to make a comparison between two different sedative (propofol vs midazolam) drugs used in combination with fentanyl.

OBJECTIVES: To compare outcomes between a combination of fentanyl and propofol with fentanyl and midazolam in patients during and after PSA.

METHODOLOGY: A randomised single blinded control trial carried out in the ED of a university hospital. 40 patients were randomly allocated equally into two groups: group A, 20 subjects received intravenous fentanyl 3 μg/kg as a bolus dose and a titration maximum bolus dose of propofol 1 mg/kg followed by a maximum titration top-up of 0.5 mg/kg if needed; group B, 20 subjects received intravenous fentanyl 3 μg/kg as a bolus dose and a titration maximum bolus dose of midazolam 0.1 mg/kg and a maximum titration top-up of 0.1 mg/kg if needed. The target sedation level was a Ramsay score of 3 or 4. Outcomes included the presence of any adverse events related to PSA and time to discharge. The Mann-Whitney U test was used to compare the two groups.

RESULTS: None of the patients developed any significant adverse events during and after procedures. The mean length of stay in the propofol and midazolam groups was 29.25 (11.03) and 71.75 (60.64) min, respectively (p<0.001).

CONCLUSION: Both propofol and midazolam given at the recommended doses were equally safe and effective for PSA in the ED. The propofol group was discharged much earlier than to the midazolam group.