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Conscious sedation and emergency department length of stay: a comparison of propofol, ketamine, and fentanyl/versed.
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MedLine Citation:
PMID:  20505814     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
STUDY OBJECTIVES: Three of the most commonly used agents for conscious sedation in the Emergency Department (ED) are ketamine, fentanyl/versed, and propofol. In this study, we measured and compared the total times spent in the ED with each of these agents. Our objective was to determine whether the use of propofol for conscious sedation was associated with a shorter length of ED stay as compared to the other two agents.
METHODS: This was a consecutive case series. All patients who required procedural conscious sedation who presented to the ED at University of California, Irvine Medical Center from January 2003 through April 2004 were included in the study. The attending ED physician evaluated the patient and determined which medication(s) would be administered. All patients underwent procedural sedation according to the ED's standardized sedation protocol. The times and dosages of administered medications and the sedation/consciousness level (SCL) scores were recorded by ED nurses at 3-5 minute intervals. Data was abstracted prospectively. The time to sedation (first dose of agent to SCL score of 2 or less) and time to recovery (last dose of agent to SCL score of 4) of the different regimens were then analyzed and compared.
RESULTS: Thirty-eight patients received propofol, 38 received ketamine, and 14 received fentanyl/versed. The mean times to sedation (minutes) were: propofol 4.5 (95% CI: 3.3-5.7), ketamine 10.6 (95% CI: 5.8-15.4), fentanyl/versed 11.5 (95% CI: 3.5-19.4). The mean times to recovery were: propofol 21.6 (95% CI: 16.1-27.1), ketamine 55.4 (95% CI: 46.2-64.5), fentanyl/versed 59.9 (95% CI: 20.3-99.5). Propofol had a statistically significant shorter time to sedation than both ketamine (p<.001) and fentanyl/versed (p=.022). Propofol also produced shorter recovery times than both ketamine (p<.001) and fentanyl/versed (p=.002).
CONCLUSION: In this study, sedation and recovery times were shorter with propofol than with ketamine or fentanyl/versed. The use of propofol for conscious sedation in this non-randomized study was associated with a shorter ED length of stay.
Authors:
Julie Gorchynski; Scott Wang; Craig Anderson; Jara Montano
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The California journal of emergency medicine / California Chapter of the American Academy of Emergency Medicine     Volume:  7     ISSN:  1948-3392     ISO Abbreviation:  Cal J Emerg Med     Publication Date:  2006 Jan 
Date Detail:
Created Date:  2010-05-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101527253     Medline TA:  Cal J Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  4-7     Citation Subset:  -    
Affiliation:
Department of Emergency Medicine, University of California, Irvine Medical Center Orange, California.
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Full Text
Journal Information
Journal ID (nlm-ta): Cal J Emerg Med
Journal ID (publisher-id): 101527253
ISSN: 1948-3384
ISSN: 1948-3392
Publisher: California Chapter of the American Academy of Emergency Medicine
Article Information
Copyright ? 2006 the authors.
open-access:
Print publication date: Season: Jan?Mar Year: 2006
Volume: 7 Issue: 1
First Page: 4 Last Page: 7
PubMed Id: 20505814
Publisher Id: cjem7-4

Conscious Sedation and Emergency Department Length of Stay: A Comparison of Propofol, Ketamine, and Fentanyl/Versed
Julie Gorchynski, MD
Scott Wang, MD
Craig Anderson, PhD
Jara Montano
Department of Emergency Medicine, University of California, Irvine Medical Center Orange, California
Correspondence: Correspondence: Julie Gorchynski, MD, MSc, FACEP, FAAEM, Associate Professor, Emergency Medicine, 101 The City Drive, Route 128, Orange, CA 92868, 714-456-5239


Article Categories:
  • Original Research


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