PAIN MANAGEMENT/CONCEPTS
Clinical Practice Advisory: Emergency Department Procedural
Sedation With Propofol
James R. Miner, MD From the Department of Emergency
Medicine, Hennepin County Medical Center, Minneapolis, MN
(Miner); and the Department of Emergency
Medicine, Albany Medical Center, Albany, NY (Burton).
John H. Burton, MD
We present an evidence-based clinical practice advisory for the
administration of propofol for emergency
department procedural sedation. We critically discuss indications,
contraindications, personnel and
monitoring requirements, dosing, coadministered medications, and
patient recovery from propofol.
Future research questions are considered. [Ann Emerg Med.
2007;50:182-187.]
Propofol Administration: Clinical Effect
Propofol is not an analgesic and serves only as a sedative and
amnestic. The clinical significance of procedural pain that a
patient experiences but cannot later recall remains unclear.
Amnesia lasts an average of 15.7 minutes in adults who have
received 1 mg/kg of propofol followed by 0.5 mg/kg until
sedated.56 Low rates of patient-reported pain or recall have been
found in ED propofol studies (10% to 12%),8-10 although the
patients in these studies all received narcotic analgesics before
the start of their procedure. Administering combinations of
propofol concurrently with analgesics may increase the
likelihood of adverse outcomes,57,58 and most of the
medications used for analgesia in the ED have half-lives that are
significantly longer than the 2- to 4-minute initial redistribution
half-life of propofol, making concurrent administration
unnecessary. Unlike midazolam and fentanyl, which are
classically titrated together, propofol should be administered as a
sole agent after complete or near-complete analgesia has been
achieved with an opiate.
*Martin Chénier*
/[EMAIL PROTECTED]/
Pierre Beaupre a écrit :
En fait, le propofol remplace le midazolam, mais pas le fentanyl.
Autrement dit, c'est un hypnotique au même titre que le midazolam,
mais il n'a pas d'action analgésique. Il faut donc préférablement
(pour le patient) y adjoindre un analgésique.
Pierre Beaupré
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*De :* [email protected] [mailto:[EMAIL PROTECTED] *De la part de*
Catherine Bich
*Envoyé :* 10 septembre 2007 20:18
*À :* [email protected]
*Objet :* URG-L: propofol
Pendant que j'y suis,quels sont ceux d'entre vous qui utlisent
définitivement le propofol pour les procedures telles la reduction de
luxation d'épaule plutôt que les combinaisons fentanyl/midazolam ?
C.
