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Abstract
Background Procedural sedation is a core skill of the emergency physician. Bolus administration of propofol is widely used in UK EDs. Titrated to an end point of sedation, it has a rapid effect but has been associated with adverse incidents. The use of a target-controlled infusion (TCI) of propofol is not routine but may reduce the incidence of adverse incidents.
The primary aims of this single-arm feasibility study were patient satisfaction and to establish recruitment rates for a randomised controlled trial comparing propofol TCI to bolus administration.
Methods Four EDs in Scotland, UK, participated. Patients aged 18-65 years, with anterior shoulder dislocation, weight ≥ 50kg, fasted ≥ 90 min were screened. Patients underwent reduction of their dislocated shoulder using TCI propofol. The primary end point was patient satisfaction recorded on a Visual Analogue Scale.
Results Between 3 April 2017 and 31 December 2018, 25 patients were recruited with a recruitment rate of 20% for the 16-month recruitment window, with a temporary pause to allow amendment of drug dosage.
Two patients were excluded. Twenty achieved adequate sedation, defined as a Modified Observer’s Assessment of Alertness/Sedation Scale (OAA/S) 3. Successful reduction was achieved in all adequately sedated. Patient satisfaction was documented in 14 patients, mean±SD of 97±9 and time to sedation was 25±8 min. No adverse events were recorded using the Society of Intravenous Anaesthesia adverse event reporting tool.
Conclusion Propofol TCI was acceptable as a method of procedural sedation for patients. The lower than expected recruitment rates highlight the need for dedicated research support.
Trial registration number NCT03442803.
- analgesia/pain control
- fractures and dislocations
- airway
- emergency department management
- safety
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Footnotes
Handling editor Katie Walker
Twitter @al_corfield
Contributors The research idea was conceived by DJL and JM and developed by FMB and MABS. FMB drafted the manuscript with editorial input from all authors. All authors read and approved the final manuscript.
Funding Funding has been awarded by CareFusion BD.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Ethical and amendment approval was given by the West of Scotland Research Ethics Committee 5, reference number 17/WS/0020 on 24 January 2017. Individual consent from the patients was obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request. Requests for data should be made to the Chief Investigator in the first instance. Data are held in a paper format in a secure archive facility (provided by Iron Mountain, Limited) and can be retrieved within 24 working hours from this facility.
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