Procedural sedation with propofol: a retrospective review of the experiences of an emergency medicine residency program 2005 to 2010

Owen McGrane, Gerald Hopkins, Adam Nielson, Christopher Kang
American Journal of Emergency Medicine 2012, 30 (5): 706-11

OBJECTIVES: The objective of this study is to evaluate the types and rates of adverse events associated with the use of propofol for procedural sedation by physicians from our emergency medicine residency program and compare those adverse event rates with those rates already published for all moderate and deep sedatives for procedural sedation, including propofol.

METHODS: This study was a retrospective chart review of all 215 procedural sedations performed with propofol in our emergency department (ED) from June 2005 to December 2010. The mean patient age was 29 years (SD, 22.1 years; range, 1-91 years). Adverse events were compiled and examined from chart data and compared with similar published studies on adverse event rates using propofol.

RESULTS: Of the 215 patients, 10 (4.65%) experienced adverse events related to procedural sedation with propofol. Our frequency of adverse events was not statistically different from the published rate for all moderate and deep sedatives (P = .407). Of all the adverse events, hypotension was the most common, occurring in 5 (2.33%) of the 215 patients. Of the 215 patients, 3 (1.40%) experienced brief hypoxia, with 2 (0.93%) of 3 patients requiring jaw thrust airway repositioning. Two (0.93%) of the 215 patients developed brief apnea that required brief bag valve mask-assisted ventilation. No patient required any advanced airway management. All 215 patients recovered completely from the procedural sedation and were discharged from the ED in stable and improved condition.

CONCLUSIONS: The adverse event rates from our study correlate with those of numerous earlier as well as recently published studies of moderate and deep sedatives, including propofol. The disciplined use of propofol by emergency physicians should continue to provide ED patients with the best available management options and care while additional focused and larger scale research is conducted to definitively confirm the premise that emergency physicians can continue to safely perform procedural sedation with propofol.

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