Use Of Propofol For Sedation Research Articles

Self‐limited febrile syndromes temporally associated with the use of propofol for sedation in gastrointestinal endoscopic procedures

To investigate cases of febrile illnesses in patients who received propofol for sedation during gastrointestinal endoscopy. Active case finding for patients who underwent endoscopy between 1 April and 30 May 2007 and suffered unexplained fever, chills, or myalgia within 48 hour after the procedure. We reviewed medications and clinical practices to find factors associated with the reactions. Seventy-four cases at eight facilities in five states were identified yielding a rate of 36 reactions per 1000 procedures, compared with a baseline rate of 0.6 per 1000. The majority of patients experienced self-limited fever (89.2%), chills (73.0%), or myalgia (63.5%). Blood samples from five patients were collected for culture; no organisms grew. All health care facilities that reported cases and fully participated in the investigation (n = 7) had received a common lot of propofol just before recognition of the first case. Bacterial endotoxin and sterility testing on unopened vials from this lot of propofol showed no abnormalities. Cases terminated after facilities stopped using the associated lot of propofol. We found a temporal association between a particular lot of propofol and an outbreak of febrile illnesses at several healthcare facilities performing endoscopy. When propofol is used to sedate patients for endoscopy, fever is a rare outcome and healthcare professionals should investigate clusters of these reactions. Post-procedure surveillance is important to identify possible medication reactions.

Propofol Use for Sedation during Endoscopy in Adults: A Canadian Association of Gastroenterology Position Statement

Over the past decade, multiple clinical reports have demonstrated that the use of propofol sedation for gastrointestinal endoscopy by gastroenterologists and trained endoscopy nurses is safe and effective in appropriately selected patients. Proposed benefits of propofol sedation include rapid onset of action, improved patient comfort and rapid clearance, as well as prompt recovery and discharge from the endoscopy unit. As a result of medical evidence, a number of international professional societies have endorsed the use of propofol in gastrointestinal endoscopy. In Canada, no formal guidelines currently exist. In the present article, the Clinical Affairs Committee of the Canadian Association of Gastroenterology presents a position statement, incorporating updated information on the use of propofol sedation for endoscopy in adult patients.

Sedation with Propofol for Routine ERCP in High-Risk Octogenarians: A Randomized, Controlled Study

Adequate patient sedation is mandatory for diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). In this respect it is known that the short-acting anesthetic propofol offers certain potential advantages for sedation during ERCP, but there are no controlled studies concerning the feasibility and safety of propofol sedation in elderly, high-risk patients. One hundred and fifty consecutive patients aged >or=80 yr with high comorbidity (ASA score >or=III: 91 %), randomly received midazolam plus meperidine (n = 75) or propofol alone (n = 75) for sedation during ERCP. Vital signs were continuously monitored and procedure-related parameters, recovery time, and quality as well as patients' cooperation and tolerance of the procedure were assessed. Clinically relevant changes in vital signs were observed at comparable frequencies with a temporary oxygen desaturation (<90%) occurring in eight patients in the propofol-group and seven patients receiving midazolam/meperidine (n.s.). Hypotension was documented in two patients in the propofol group and one patient receiving midazolam/meperidine. Propofol provided a significantly better patient cooperation than midazolam/meperidine (p < 0.01), but the procedure tolerability was rated nearly the same by both groups. Mean recovery time was significantly shorter in the propofol group (22 +/- 7 min vs 31 +/- 8 min for midazolam/meperidine (p < 0.01)) while the recovery score was significantly higher under propofol (8.3 +/- 1.2 vs 6.1 +/- 1.1(p < 0.01)). During recovery a significant lower number of desaturation events (<90%) were observed in the propofol group (12%) than in the midazolam/meperidine group (26%, p < 0.01). Under careful monitoring the use of propofol for sedation during ERCP is superior to midazolam/meperidine even in high-risk octogenarians.

Upper Airway Collapsibility

Upper Airway Collapsibility

Propofol for Sedation in the Endoscopy Setting

Intravenous sedation is routinely administered for endoscopic examinations to help alleviate patient anxiety and discomfort. The goal of moderate sedation is to provide patient comfort to facilitate the completion of the procedure. Nurse administration of intravenous meperidine and midazolam under the direct supervision of the gastroenterologist is the traditional method for achieving this outcome. More recently, physicians have been requesting monitored anesthesia care for the administration of propofol when performing procedures expected to be technically difficult. Propofol is a rapid acting sedative-hypnotic that produces the desired level of consciousness without the residual sedative effect that often persists with the use of benzodiazepines and analgesics. This article reviews current literature regarding the use of propofol for sedation of patients in the endoscopy setting, and highlights the trends in research that may impact future nursing practice.

Myoclonic and Tonic-Clonic Seizures after Propofol Sedation during a Brachial Plexus Block: A case report

Propofol has become a popular intravenous agent for the induction and maintenance of total intravenous anesthesia (TIVA). However, the pro- or anticonvulsant properties of propofol remain controversial and abnormal muscle movement and convulsive activity are possible side-effects. We report a case in which a healthy 42-year-old man developed myoclonic and tonic-clonic seizures related to the use of propofol for sedation during a brachial plexus block.

Propofol use during gastrointestinal endoscopy: November 2000

Propofol use during gastrointestinal endoscopy: November 2000

Intensive care sedation: a review of current British practice.

Sedation is central to the management of intensive care patients. Many different techniques have been tried, all have potential side effects, and some have been associated with serious adverse effects. The aim of this work is to establish current sedation practice in British ICUs; the use of neuromuscular blocking drugs and the indications for their use, the use of sedation policies and scoring systems, the influence of cost on drug choice, and the use of propofol for sedation in paediatric patients. A postal survey sent to all units identified in the Directory of Emergency Services. Two hundred and fifty-five replies were received from 323 questionnaires (79% response rate). The replies show that alfentanil, morphine, midazolam, and propofol are the most widely used drugs for sedation, and that changes occur in sedation policy with the time a patient spends in intensive care. Atracurium is the most widely used neuromuscular blocking drug, but the number of patients who receive therapeutic paralysis is relatively small and the indications for its use in different units is consistent. Propofol is used by many ICUs for the sedation of children despite reports linking its use to mortality in children and the advice of the regulatory authorities. Drugs used for the sedation of patients in intensive care have changed since previous surveys. The sedation policy of most units relies on the combination of small numbers of drugs. Sedation policies now seem to concentrate on achieving a lightly sedated co-operative patient.

Use of propofol for sedation in the ICU

Use of propofol for sedation in the ICU

The Use of Propofol for Sedation in the Emergency Department

To evaluate the effectiveness of propofol and fentanyl when used by emergency physicians (EPs) for systemic sedation and analgesia in the ED. Over an eight-month period, a convenience sample of consenting patients at an urban teaching hospital ED who required sedation for painful procedures were enrolled in a descriptive study of therapeutic propofol sedation. After receiving 2 micrograms/kg of fentanyl i.v. the patients received a continuous infusion of propofol at 0.21 mg/kg/min i.v. to the desired level of sedation. A maintenance infusion of 3-6 mg/kg/hr was administered during the remainder of the procedure. Sedation time, total procedure time, and recovery time were recorded and the presence of side effects was noted. The patients and the physicians rated their satisfaction with the technique on a 100-mm visual analog scale. The patients were contacted at 24 hours for follow-up information. Twenty patients (aged 19-62 years) received propofol infusion for procedures that included ten abscess incision and drainages, eight orthopedic reductions, one chest tube placement, and one wound exploration. The mean (+/- SD) total dose of propofol was 200 +/- 160 mg. The mean time to onset of sedation was 6.6 +/- 3.2 min, the mean procedure interval was 9.6 +/- 6.3 min, and the mean interval until recovery was 6.1 +/- 4.1 min. The median patient satisfaction score was 97 mm (range 40-100 mm); the median rating by physicians was 88 mm (range 4-100 mm). Side effects were noted in six patients: three had pain on injection, one had pain on injection and brief (< 1 min) hypotension (systolic blood pressure = 80 mm Hg), and two had apnea (< 30 sec). Seven patients had some recall of the procedure immediately afterwards, but only five had any recall at 24 hours. All 20 patients stated they would be willing to receive the same sedation again for a future procedure. Propofol appears to be an effective agent to provide systemic sedation and analgesia when used in conjunction with fentanyl for procedures in the ED. Given its rapidity of onset and elimination, it may become a useful agent to EPs for i.v. sedation in the ED.

The use of propofol for sedation of critically ill patients undergoing haemodiafiltration.

To assess the requirement for propofol to provide sedation in critically ill patients in established renal failure during the commencement of haemodiafiltration. Prospective clinical study. ICU, University Hospital. 10 adult patients. All were mechanically ventilated, had acute oliguric renal failure which necessitated continuous veno-venous haemodiafiltration and were receiving a continuous intravenous infusion of propofol for sedation. Sedation was assessed using a scoring system. Veno-venous haemodiafiltration. Connection of the extracorporeal circuit produced a reduction in plasma propofol concentration in 7 out of 9 patients (one sample misplaced) with subsequent awakening in 3 of these 7 patients. The commencement of haemodiafiltration itself did not significantly influence the requirement for propofol (8 out of 10 patients). Haemodiafiltration does not substantially influence the requirement for propofol but the initial introduction of the extracorporeal circuit will reduce plasma concentrations in the majority of patients. This may be due to haemodilution alone or absorption of plasma albumin (with propofol) onto the membrane.

Propofol infusion for sedation of children

Propofol prepared as an aqueous soya bean emulsion formulation has been used successfully as a continuous infusion to sedate adult patients undergoing mechanical ventilation in ICUs. We have found only one reference describing the use of propofol for sedation of children. A propofol infusion was used to accomplish satisfactory sedation with a non accumulating agent in three children refractory to other medications

Use of propofol for sedation during gastrointestinal endoscopies.

This study investigated the suitability of propofol as a sole agent for continuous sedation in 100 unpremedicated patients during gastrointestinal endoscopy. The propofol was given very slowly (average 62.7 seconds) in order to prevent apnoea during induction, and the dose adjusted according to age (68% of patients were older than 50 years) and ASA grade (32% were ASA grade 3 or 4). There was no correlation under these circumstances between the observed haemodynamic variations and the age or ASA grade of the patients. The infusion rate during maintenance was also adjusted for age, and for the type of endoscopy. The mean rate was 4.3 mg/kg/hour. Recovery was rapid and of excellent quality; 77 patients were awake within 10 minutes and 99 reported total amnesia.