Profiling adverse respiratory events and vomiting when using propofol for emergency department procedural sedation.

Abstract

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.

• Authors: Anthony Bell, Greg Treston, Charley McNabb, Kathy Monypenny, Robert Cardwell
• Journal: Emergency medicine Australasia : EMA (Emerg Med Australas) Vol. 19 Issue 5 Pg. 405-10 (Oct 2007) ISSN: 1742-6731 [Print] Australia
• PMID: 17919212 (Publication Type: Journal Article)

Chemical References

• Hypnotics and Sedatives
• Propofol

Topics

• Adolescent
• Adult
• Adverse Drug Reaction Reporting Systems
• Aged
• Conscious Sedation (adverse effects, methods)
• Emergency Service, Hospital
• Female
• Health Status Indicators
• Humans
• Hypnotics and Sedatives (adverse effects, therapeutic use)
• Male
• Middle Aged
• Propofol (adverse effects, therapeutic use)
• Prospective Studies
• Respiratory Function Tests
• Respiratory Tract Diseases (chemically induced)
• Risk Factors
• Time Factors
• Vomiting (chemically induced)