Study objective:
We determine the safety and efficacy of propofol sedation for painful procedures in the emergency department (ed).
Methods:
A consecutive case series of propofol sedations for painful procedures in the ed of a tertiary care pediatric hospital from july 2000 to july 2002 was performed. a sedation protocol was followed. propofol was administered in a bolus of 1 mg/kg, followed by additional doses of 0.5 mg/kg. narcotics were administered 1 minute before propofol administration. adverse events were documented, as were the sedation duration, recovery time from sedation, and total time in the ed.
Results:
Three hundred ninety-three discrete sedation events with propofol were analyzed. procedures consisted of the following: fracture reductions (94%), reduction of joint dislocations (4%), spica cast placement (2%), and ocular examination after an ocular burn (0.3%). the median propofol dose was 2.7 mg/kg. ninety-two percent of patients had a transient (<or=2 minutes) decrease in systolic blood pressure without clinical signs of poor perfusion. nineteen (5%) patients had hypoxia, 11 (3%) patients required airway repositioning or jaw-thrust maneuvers, and 3 (0.8%) patients required bag-valve-mask ventilation. no patient required endotracheal intubation.
Conclusion:
Propofol sedation is efficacious and can be used safely in the ed setting under the guidance of a protocol. transient cardiopulmonary depression occurs, which requires vigilant monitoring by highly skilled practitioners. propofol is well suited for short, painful procedures in the ed setting.