2.50
Hdl Handle:
http://hdl.handle.net/10755/162544
Type:
Presentation
Title:
Procedural Sedation in the Emergency Department: An Exploratory Study
Abstract:
Procedural Sedation in the Emergency Department: An Exploratory Study
Conference Sponsor:Emergency Nurses Association
Conference Year:2009
Author:Schmedel, Wayne, RN, BS, CCRN
P.I. Institution Name:Providence St. Vincent Medical Center
Title:Staff Nurse
Contact Address:9205 SW Barnes Road, Portland, OR, 97225, USA
Contact Telephone:503-216-2361
[Annual Conference Research Poster] Purpose: Efficacy of the particular emergency department (ED) sedation agent was defined as having shorter procedural sedation time, absence of pulmonary or hemodynamic changes, and a deeper level of sedation achieved. Midazolam with fentanyl and propofol were the agents that were compared.

Design: This was a retrospective observational non-randomized study of emergency department patients requiring procedural sedation comparing the clinical efficacy of midazolam with fentanyl and propofol.

Setting: A community non-profit 400 bed teaching hospital with a 50 bed emergency department was the research site.

Sample: 120 patients (100 received propofol and 20 received midazolam with fentanyl) were selected as a convenience sample based on the first 120 patients who received these sedation agents. There were 58 females and 62 males with a mean age of 44 (range of 1 to 96) during a three month study period. Approval for the study was obtained by the regional IRB.

Methodology: The first 120 patients who received either propofol or midazolam with fentanyl were enrolled into the study during a retrospective quality improvement audit for emergency department procedural sedation. Physiological variables (blood pressure, heart rate, respiratory rate, and oxygen saturation) were recorded at baseline and when the level of sedation was highest and notes were recorded if there were any physiologic compromise or complication during the entire procedural sedation. The Ramsey score was also continuously recorded which defined the level of sedation. Deep sedation was defined when the Ramsey score was either 5 or 6.

Results: Patients receiving propofol had a significant deeper level of sedation (mean 3.9) compared to midalzolam with fentanyl (mean 2.8) but propofol had a much shorter time of sedation monitoring (mean 36.3 minutes) compared to the patients receiving midazolam and fentanyl (56.1 minutes). Using the Student's t-test, propofol had a significant deeper level of sedation (p < 0.001) and propofol also had a significantly shorter procedural sedation time (p < 0.01). There were no significant differences in physiologic variables between the two agents.

Conclusions: Propofol when compared to midazolam with fentanyl provides a much deeper level of sedation as well as a much more rapid recovery time. The deeper level of sedation conceivably provides the patient with a more pleasant procedural sedation experience. The shorter procedural sedation time has implications of decreasing required health care resources and can directly reduce ED overcrowding.

Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleProcedural Sedation in the Emergency Department: An Exploratory Studyen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162544-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Procedural Sedation in the Emergency Department: An Exploratory Study</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Schmedel, Wayne, RN, BS, CCRN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Providence St. Vincent Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Staff Nurse</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">9205 SW Barnes Road, Portland, OR, 97225, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">503-216-2361</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">wayne.schmedel@providence.org</td></tr><tr><td colspan="2" class="item-abstract">[Annual Conference Research Poster] Purpose: Efficacy of the particular emergency department (ED) sedation agent was defined as having shorter procedural sedation time, absence of pulmonary or hemodynamic changes, and a deeper level of sedation achieved. Midazolam with fentanyl and propofol were the agents that were compared. <br/> <br/> Design: This was a retrospective observational non-randomized study of emergency department patients requiring procedural sedation comparing the clinical efficacy of midazolam with fentanyl and propofol. <br/> <br/> Setting: A community non-profit 400 bed teaching hospital with a 50 bed emergency department was the research site. <br/> <br/> Sample: 120 patients (100 received propofol and 20 received midazolam with fentanyl) were selected as a convenience sample based on the first 120 patients who received these sedation agents. There were 58 females and 62 males with a mean age of 44 (range of 1 to 96) during a three month study period. Approval for the study was obtained by the regional IRB. <br/> <br/> Methodology: The first 120 patients who received either propofol or midazolam with fentanyl were enrolled into the study during a retrospective quality improvement audit for emergency department procedural sedation. Physiological variables (blood pressure, heart rate, respiratory rate, and oxygen saturation) were recorded at baseline and when the level of sedation was highest and notes were recorded if there were any physiologic compromise or complication during the entire procedural sedation. The Ramsey score was also continuously recorded which defined the level of sedation. Deep sedation was defined when the Ramsey score was either 5 or 6. <br/> <br/> Results: Patients receiving propofol had a significant deeper level of sedation (mean 3.9) compared to midalzolam with fentanyl (mean 2.8) but propofol had a much shorter time of sedation monitoring (mean 36.3 minutes) compared to the patients receiving midazolam and fentanyl (56.1 minutes). Using the Student's t-test, propofol had a significant deeper level of sedation (p &lt; 0.001) and propofol also had a significantly shorter procedural sedation time (p &lt; 0.01). There were no significant differences in physiologic variables between the two agents. <br/> <br/> Conclusions: Propofol when compared to midazolam with fentanyl provides a much deeper level of sedation as well as a much more rapid recovery time. The deeper level of sedation conceivably provides the patient with a more pleasant procedural sedation experience. The shorter procedural sedation time has implications of decreasing required health care resources and can directly reduce ED overcrowding.<br/><br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:29:59Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:29:59Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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