Etomidate and Midazolam for Procedural Sedation in the Emergency Department of Queen Elizabeth Hospital: A Randomised Controlled Trial

Abstract

Objective The objective of the study was to compare the effectiveness and safety of intravenous etomidate against midazolam in procedures which required sedation and analgesia in our emergency department. Methods The study was conducted in the emergency department of Queen Elizabeth Hospital from 1st November 2005 to 30th June 2006. Adult patients who required procedural sedation and analgesia were recruited and randomised into two groups, in which either etomidate or midazolam was used as the sedative agent. Vital parameters and depth of sedation were closely monitored until they regained full consciousness. Results a total of 87 patients were recruited and randomised into study and control groups, of which 78 patients completed the study and were analysed – 36 patients were in the midazolam group whereas 42 patients were in the etomidate group. There was no statistical difference in mean age, mean weight and procedures between the two groups. Mean time for onset of action was 1.8 minutes for the etomidate group versus 3.4 minutes for the midazolam group (p=0.003). There were no significant differences in total procedure time, total length of stay, pain score, satisfaction score and adverse effects. Conclusion Etomidate achieved adequate depth of sedation for painful procedures in significantly shorter time than midazolam. There were no differences in procedure time, length of stay, pain relief and patient's satisfaction between the two drugs.