A retrospective review of a propofol procedural sedation protocol in a community hospital

Abstract

Study objectives: We evaluate a newly implemented propofol procedural sedation protocol at our institution for efficacy, safety, and adherence to the protocol guidelines and make recommendations to change the protocol if required. Methods: This was a retrospective medical record review of all patients older than 16 years who received propofol for procedural sedation using a preprinted protocol in the emergency department (ED) or critical care unit between January 2002 and November 2002. The protocol dosing for propofol was based on age, weight, and concurrent opioid use: patients aged 16 to 55 years received a 0.5 mg/kg intravenous bolus of propofol and then 10 to 20 mg intravenously every 30 to 60 seconds as needed; patients aged 55 or older or younger patients receiving concurrent opioids received a 0.25 mg/kg intravenous bolus of propofol, followed by 10 to 20 mg intravenously every 1 to 2 minutes as needed. We recorded data to evaluate the efficacy and safety of current protocol guidelines. Results: Forty-seven patients were included in the study, and their demographics, dosing information, and adverse events were recorded on standardized data collection forms. Electrocardioversion was performed on 27 (57%) patients, whereas 20 (43%) patients underwent various emergency procedures. The average total propofol dose received was 90.3 mg (±53.1 mg), and the average number of doses given was 3.6 (±2.1). The average time to sedation from initial propofol dose was 4.2 minutes (±4.0 minutes). Sedation scores were recorded for 25 patients (53%); effective sedation was achieved in 68% of these patients. Adverse events occurred in 10 patients (21%); none of them were critical or resulted in prolonged hospital stay or admission. The propofol bolus dosing guidelines were adhered to in only 43% of patients. Conclusion: The protocol demonstrated suboptimal efficacy but appeared to be safe. According to the results, we recommended increasing propofol bolus doses to allow for faster and more effective sedation. The dose changes were propofol 0.8 mg/kg for patients aged 16 to 55 years and propofol 0.4 mg/kg for patients 55 years or older; dosing adjustment for patients with concurrent opioid use was eliminated.