What is the role of propofol in emergency department (ED) sedation?

Updated: Nov 06, 2018
  • Author: Arul M Lingappan, MD; Chief Editor: Erik D Schraga, MD  more...
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Answer

Answer

Nonbarbiturate sedatives have all of the sedative properties of barbiturates. They have gained significant popularity in ED procedural sedation. The two most commonly used (and studied) are propofol and etomidate.

Propofol is an alkyl phenol derivative compound prepared in a 10% lipid emulsion. Originally promoted as an anesthetic induction agent, propofol is also used as a short-acting sedative for bolus administration or continuous infusion. It has a rapid onset of action (< 1 min) and short duration of action (approximately 10 min but is dose-dependent). Clearance of the drug is not affected by renal or hepatic dysfunction, as it has no active metabolites.

Propofol is a respiratory and cardiovascular depressant; these effects have limited its use in the ED in the past, but it has become very popular, particularly for deep procedural sedation. [6, 7, 8, 9] It has been studied in fracture dislocation, incision and drainage, and cardioversion. [9] Propofol can be used in the ED as a sedative for short-term procedures, starting with 1 mg/kg and titrating to effect in increments of 0.5 mg/kg in adults. [6, 5] This also is a very good agent for sedation in patients receiving mechanical ventilation; under these circumstances, it is administered as a continuous infusion starting at 5-10 mcg/kg/min and then titrated to effect.

The total dose given typically ranges from 25-125 mcg/kg/min. It has direct cardiodepressant effects, leading to decreased blood pressure and heart rate. As propofol is a pure sedative/amnestic, an analgesic should be given prior to its administration; giving them simultaneously increases risk for adverse effects. [9, 10]

Blood pressure should be frequently monitored during titration. Patients who have underlying disease (American Society of Anesthesiologists [ASA] Class 3 or 4) are at increased risk for developing hypotension. [9] The suppression of hypoxic respiratory drive is dose-dependent. Patients who need ventilator support are generally older. [9, 11] Propofol is contraindicated in patients with allergies to soybean or eggs. [12]


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