Annals of Emergency Medicine
Volume 50, Issue 2 , Pages 182-187.e1 , August 2007

Clinical Practice Advisory: Emergency Department Procedural Sedation With Propofol

  • James R. Miner, MD

      Affiliations

    • Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN
    • ,
  • John H. Burton, MD

      Affiliations

    • Department of Emergency Medicine, Albany Medical Center, Albany, NY.
    • Corresponding Author InformationAddress for correspondence: John H. Burton, MD, Department of Emergency Medicine, Albany Medical College, 43 New Scotland Avenue, MC 139, Albany, NY 12208; 518-262-4050; fax 518-262-3236

Received 12 June 2006 ,Revised 8 December 2006 ,Accepted 20 December 2006.

References 

  1. Swanson ER, Seaberg DC, Mathias S. The use of propofol for sedation in the emergency department. Acad Emerg Med. 1996;3:234–238
  2. Havel CJ, Strait RT, Hennes H. A clinical trial of propofol vs. midazolam for procedural sedation in a pediatric emergency department. Acad Emerg Med. 1999;6:989–997
  3. Green SM. Propofol for emergency department procedural sedation: not yet ready for prime time. Acad Emerg Med. 1999;6:975–978
  4. Bassett KE, Anderson JL, Pribble CG, et al. Propofol for procedural sedation in children in the emergency department. Ann Emerg Med. 2003;42:773–782
  5. Burton JH, Miner JR, Shipley ER, et al. Propofol for emergency department procedural sedation and analgesia: a tale of three centers. Acad Emerg Med. 2006;13:24–30
  6. Coll-Vinent B, Sala X, Fernández C, et al. Sedation for cardioversion in the emergency department: analysis of effectiveness in four protocols. Ann Emerg Med. 2003;42:767–772
  7. Guenther E, Pribble CG, Junkins EP, et al. Propofol sedation by emergency physicians for elective pediatric outpatient procedures. Ann Emerg Med. 2003;42:783–791
  8. Miner JR, Biros MH, Krieg S, et al. Randomized clinical trial of propofol versus methohexital for procedural sedation during fracture and dislocation reduction in the emergency department. Acad Emerg Med. 2003;10:931–937
  9. Miner JR, Biros MH, Heegaard W, et al. Bispectral electroencephalographic analysis of patients undergoing procedural sedation in the emergency department. Acad Emerg Med. 2003;10:638–643
  10. Miner JR, Biros MH, Seigel T, et al. The utility of bispectral index in procedural sedation with propofol in the emergency department. Acad Emerg Med. 2005;12:190–196
  11. Miner JR, Heegaard W, Plummer D. End-tidal carbon dioxide monitoring during procedural sedation. Acad Emerg Med. 2002;9:275–280
  12. Miner JR, Martel ML, Meyer M, et al. Procedural sedation of critically ill patients in the emergency department. Acad Emerg Med. 2005;12:124–128
  13. Skokan EG, Pribble C, Bassett KA, et al. Use of propofol sedation in a pediatric emergency department: a prospective study. Clin Pediatr. 2001;40:663–671
  14. Miner JR, Danahy M, Moch A, et al. Randomized clinical trial of etomidate versus propofol for procedural sedation in the emergency department. Ann Emerg Med. 2007;49:15–22
  15. Anderson JL, Junkins E, Pribble C, et al. Capnography and depth of sedation during propofol sedation in children. Ann Emerg Med. 2007;49:9–14
  16. Taylor DMD, O’Brien D, Ritchie P, et al. Propofol versus midazolam/fentanyl for reduction of anterior shoulder dislocation. Acad Emerg Med. 2005;12:13–19
  17. Frank LR, Strote J, Hauff SR, et al. Propofol by infusion protocol for ED procedural sedation. Am J Emerg Med. 2006;24:599–602
  18. Green SM, Krauss B. Clinical practice guideline for emergency department ketamine dissociative sedation in children. Ann Emerg Med. 2004;44:460–471
  19. Mace S, Barata I, Cravero J, et al. Clinical policy: evidence-based approach to pharmacologic agents used in pediatric sedation and analgesia in the emergency department. Ann Emerg Med. 2004;44:342–377
  20. Bahn EL, Holt KR. Procedural sedation and analgesia: a review and new concepts. Emerg Med Clin North Am. 2005;23:503–517
  21. Godwin SA, Caro DA, Wolf SJ, et al. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2005;45:177–196
  22. American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by nonanesthesiologists. Anesthesiology. 2002;96:1004–1017
  23. Joint Commission Accreditation Healthcare Organizations. 2006 Comprehensive Accreditation Manual for Hospitals: The Official Handbook: Provision of Care, Treatment and Services (Operative or Other High Risk Procedures and/or Administration of Moderate or Deep Sedation or Anesthesia). Oakbrook Terrace, IL: Joint Commission Accreditation Healthcare Organizations; 2006;
  24. Burton JH, Vinson DR, Drummond K, et al. Electrical cardioversion of emergency department patients with atrial fibrillation. Ann Emerg Med. 2004;44:20–30
  25. Godambe SA, Eliot V, Matheny D. Comparison of propofol/fentanyl versus ketamine/midazolam for brief orthopedic procedural sedation in a pediatric emergency department. Pediatrics. 2003;112:116–123
  26. Meyers CJ, Eisig SB, Kraut RA. Comparison of propofol and methohexital for deep sedation. J Oral Maxillofac Surg. 1994;52:448–452
  27. Pershad J, Godambe SA. Propofol for procedural sedation in the pediatric emergency department. J Emerg Med. 2004;27:11–14
  28. Ward KR, Yealy DM. Systemic analgesia and sedation in managing orthopedic emergencies. Emerg Med Clin North Am. 2000;18:141–166
  29. Wheeler DS, Vaux KK, Ponaman ML, et al. The safe and effective use of propofol sedation in children undergoing diagnostic and therapeutic procedures: experience in a pediatric ICU and a review of the literature. Pediatr Emerg Care. 2003;19:385–392
  30. Miner JR, Nichol S, Biros M. The effect of the assignment of a presedation target level on procedural sedation using propofol. J Emerg Med. In press.
  31. Astra-Zeneca, Diprivan. [package insert]. Accessed April 1, 2005.
  32. Kazama T, Ikeda K, Morita K, et al. Comparison of the effect-site k(eO)s of propofol for blood pressure and EEG bispectral index in elderly and younger patients. Anesthesiology. 1999;90:1517–1527
  33. Schnider TW, Minto CF, Shaferet SL, et al. The influence of age on propofol pharmacodynamics. Anesthesiology. 1999;90:1502–1516
  34. American Society of Anesthesiologists. Physical status classification system. Available at: http://www.asahq.org/clinical/physicalstatus.htm. Accessed June 15, 2005.
  35. Hoffman GM, Nowakowski R, Troshynskiet TJ, et al. Risk reduction in pediatric procedural sedation by application of an American Academy of Pediatrics/American Society of Anesthesiologists process model. Pediatrics. 2002;109:236–243
  36. Illievich UM, Petricek W, Schramm W, et al. Electroencephalographic burst suppression by propofol infusion in humans: hemodynamic consequences. Anesth Analg. 1993;77:155–160
  37. Wahr JA, Plunkett JJ, Ramsay JG, et al. Cardiovascular responses during sedation after coronary revascularization: incidence of myocardial ischemia and hemodynamic episodes with propofol versus midazolam: Institutions of the McSPI Research Group. Anesthesiology. 1996;84:1350–1360
  38. Kelly DF, Goodale DB, Williams J, et al. Propofol in the treatment of moderate and severe head injury: a randomized, prospective double-blinded pilot trial. J Neurosurg. 1999;90:1042–1052
  39. Lim M, Ellahee P. Recommendations for postinduction hypotension: are they supported by the evidence?. Anesth Analg. 2006;102:1589–1590
  40. Chamorro C, de Latorre FJ, Montero A, et al. Comparative study of propofol versus midazolam in the sedation of critically ill patients: results of a prospective, randomized, multicenter trial. Crit Care Med. 1996;24:932–939
  41. Agrawal D, Manzi SF, Gupta PDR, et al. Preprocedural fasting state and adverse events in children undergoing procedural sedation and analgesia in a pediatric emergency department. Ann Emerg Med. 2003;42:636–646
  42. Green SM, Krauss B. Pulmonary aspiration risk during emergency department procedural sedation: an examination of the role of fasting and sedation depth. Acad Emerg Med. 2002;9:35–42
  43. Green SM, Miner J, Burton JH, et al. Fasting and emergency department procedural sedation and analgesia: a consensus-based clinical practice advisory. Ann Emerg Med. In press.
  44. American Society of Anesthesiologists. Statement on the safe use of propofol. Available at: http://www.asahq.org. Accessed June 15, 2005.
  45. Sacchetti A, Senula G, Strickland J, et al. Procedural sedation in the community emergency department: initial results of the ProSCED registry. Acad Emerg Med. 2007;14:41–46
  46. Walker JA, McIntyre RD, Schleinitz PF, et al. Nurse-administered propofol sedation without anesthesia specialists in 9152 endoscopic cases in an ambulatory surgery center. Am J Gastroenterol. 2003;98:1744–1750
  47. Tohda G, Higashi S, Sakumoto H, et al. Propofol sedation during endoscopic procedures: safe and effective administration by registered nurses supervised by endoscopists. Endoscopy. 2006;38:360–367
  48. Rex DK, Heuss LT, Walker JA, et al. Trained registered nurses/endoscopy teams can administer propofol safely for endoscopy. Gastroenterology. 2005;129:1384–1391
  49. Lin DM. In: Sedation, Analgesia, and JCAHO. Marblehead, MA: HC Pro, Inc; 2005;p. 20
  50. Glass PS, Bloom M, Kearse L. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology. 1997;86:836–847
  51. Leslie K, Sessler DI, Schroeder M, et al. Propofol blood concentration and the Bispectral Index predict suppression of learning during propofol/epidural anesthesia in volunteers. Anesth Analg. 1995;81:1269–1274
  52. Shafer SL. Advances in propofol pharmacokinetics and pharmacodynamics. J Clin Anesth. 1993;5:14S–21S
  53. Shafer A, Doze VA, Shafer SL, et al. Pharmacokinetics and pharmacodynamics of propofol infusions during general anesthesia. Anesthesiology. 1988;69:348–356
  54. Vardi A, Salem Y, Padeh S, et al. Is propofol safe for procedural sedation in children? (a prospective evaluation of propofol versus ketamine in pediatric critical care). Crit Care Med. 2002;30:1231–1236
  55. Barbi E, Gerarduzzi T, Marchetti F, et al. Deep sedation with propofol by nonanesthesiologists: a prospective pediatric experience. Arch Pediatr Adolesc Med. 2003;157:1097–1103
  56. Miner JR, Bachman A, Kosman L. Assessment of the onset and persistence of amnesia during procedural sedation with propofol. Acad Emerg Med. 2005;12:491–496
  57. Burton JH, Harrah JD, Germann CA, et al. Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices?. Acad Emerg Med. 2006;13:500–504
  58. American College of Emergency Physicians. Clinical policy for procedural sedation and analgesia in the emergency department. Ann Emerg Med. 1998;31:663–677
  59. Hart LS, Berns SD, Houck CS, et al. The value of end-tidal CO2 monitoring when comparing three methods of conscious sedation for children undergoing painful procedures in the emergency department. Pediatr Emerg Care. 1997;13:189–193
  60. Prstojevich SJ, Sabol SR, Goldwasser MS, et al. Utility of capnography in predicting venous carbon dioxide partial pressure in sedated patients during outpatient oral surgery. J Oral Maxillofac Surg. 1992;50:37–39
  61. Tobias JD. End-tidal carbon dioxide monitoring during sedation with a combination of midazolam and ketamine for children undergoing painful, invasive procedures. Pediatr Emerg Care. 1999;15:173–175
  62. Jurell KR, O’Connor KW, Slack J, et al. Effect of supplemental oxygen on cardiopulmonary changes during gastrointestinal endoscopy. Gastrointest Endosc. 1994;40:665–670
  63. Deitch K, Chudnofsky CR, Dominici P. The utility of supplemental oxygen during emergency department procedural sedation and analgesia with midazolam and fentanyl: a randomized, controlled trial. Ann Emerg Med. 2007;49:1–8
  64. Frazee BW, Park RS, Lowery D, et al. Propofol for deep procedural sedation in the ED. Am J Emerg Med. 2005;23:190–195
  65. Pena BM, Krauss B. Adverse events of procedural sedation and analgesia in a pediatric emergency department. Ann Emerg Med. 1999;34:483–491
  66. Picard P, Tramer MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anesth Analg. 2000;90:963–969
  67. Nathanson MH, Gajraj NM, Russell JA. Prevention of pain on injection of propofol: a comparison of lidocaine with alfentanil. Anesth Analg. 1996;82:469–471

 Supervising editor: Steven M. Green, MDFunding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.Available online February 23, 2007.Reprints not available from the authors.

PII: S0196-0644(06)02686-2

doi: 10.1016/j.annemergmed.2006.12.017

Annals of Emergency Medicine
Volume 50, Issue 2 , Pages 182-187.e1 , August 2007

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