Propofol versus midazolam for procedural sedation in the emergency department: A study on efficacy and safety

Background: Procedural sedation for painful procedures in the emergency department (ED) can be accomplished with various pharmacological agents. The choice of the sedative used is highly dependent on procedure- and patient characteristics and on personal- or local preferences. Methods: We conducted a multicenter retrospective cohort study of procedural sedations performed in the EDs of 5 hospitals in the Netherlands over a 4 year period to evaluate the efficacy- (success rate of the intended procedure) and safety (incidence of sedation (adverse) events) of propofol sedations compared to midazolam sedations. Results: A total of 592 ED sedations were included in our study. Patients sedated with propofol (n = 284, median dose 75 mg) achieved a deeper level of sedation (45% vs. 25% deep sedation, p < 0.001), had a higher procedure success rate (92% vs. 81%, p < 0.001) and shorter median sedation duration (10 vs. 17 min, p < 0.001) compared to patients receiving midazolam (n = 308, median dose 4 mg). A total of 112 sedation events were registered for 99 patients. Transient apnea was the most prevalent event (n = 73), followed by oxygen desaturation (n = 18) airway obstruction responsive to simple maneuvers (n = 13) and hypotension (n = 6). Propofol sedations were more often associated with the occurrence of apnea's (20% vs. 10%, p = 0.004), whereas clinically relevant oxygen desaturations (<90%) were found more often in patients sedated with midazolam (8% vs. 1%, p = 0.001). No sedation adverse events were registered Conclusion: Propofol is more effective and at least as safe as midazolam for procedural sedation in the ED. (C) 2017 Elsevier Inc. All rights reserved.