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Profiling adverse respiratory events and vomiting when using propofol for emergency department procedural sedation
Author(s) -
Bell Anthony,
Treston Greg,
McNabb Charley,
Monypenny Kathy,
Cardwell Robert
Publication year - 2007
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/j.1742-6723.2007.00982.x
Subject(s) - medicine , propofol , sedation , laryngospasm , anesthesia , vomiting , interquartile range , emergency department , adverse effect , confidence interval , airway , surgery , psychiatry
Objectives: To evaluate the rate of adverse respiratory events and vomiting among ED patients undergoing procedural sedation with propofol. Methods: This was a prospective, observational series of patients undergoing procedural sedation. Titrated i.v. propofol was administered via protocol. Fasting status was recorded. Results: Four hundred patients undergoing sedation were enrolled. Of these 282 (70%, 95% confidence interval [CI] 66–75%) had eaten or drunken within 6 and 2 h, respectively. Median fasting times from a full meal, snack or drink were 7 h (interquartile range [IQR] 5–9 h), 6 h (IQR 4–8 h) and 4 h (IQR 2–6 h), respectively. Overall a respiratory event occurred in 86 patients (22%, 95% CI 18–26%). An airway intervention occurred in 123 patients (31%, 95% CI 26–35%). In 111 cases (90%, 95% CI 60–98%) basic airway manoeuvres were all that was required. No patients were intubated. Two patients vomited (0.5%, 95% CI 0.0–1.6%), one during sedation, one after patient became conversational. One patient developed transient laryngospasm (0.25%, 95% CI 0–1.2%) unrelated to vomiting. There were nil aspiration events (0%, 95% CI 0–0.74%). Conclusions: Seventy per cent of patients undergoing ED procedural sedation are not fasted. No patient had a clinically evident adverse outcome. Transient respiratory events occur but can be managed with basic airway interventions making propofol a safe alternative for emergency physicians to provide emergent procedural sedation.