New practice guideline outlines safe use of propofol in ED

Despite the lay perception of propofol in the wake of Michael Jackson’s death, it has been shown to be safe and effective when used by appropriately trained providers, according to many high-quality published studies.

In a clinical practice guideline published in the February 2019 issue of Annals of Emergency Medicine, a team of emergency physicians evaluated literature published between 2007 and 2018 related to propofol use in emergency departments (EDs). The team’s goal was to produce an evidence-based recommendation for administration, monitoring, and recovery considerations for propofol use in deep procedural sedation in the ED. 

Because propofol use can easily overshoot sedation goals, the authors stated that preparing to manage deeper levels of sedation is mandatory, even if only targeting moderate to light sedation.

Evaluating patients for contraindications to propofol is the first step in safe propofol use.

Risks of sedation-related adverse effects are more common in children younger than 6 months or patients older than 50 (with patients older than 75 at most risk among adult patients). 

Best practice entails having two providers present during deep sedation scenarios, unless an emergency dictates otherwise. If the provider administering deep sedation is also the person administering the procedure, the provider must be prepared to stop the procedure to resuscitate the patient if needed.

Propofol is a sedative and amnestic, but not an analgesic. Its onset of action is 30 to 60 seconds, and its duration of action is less than 10 minutes. Thus, fentanyl, ketamine, or local anesthetics should be used for pain management during procedures in which pain is present because the implications of experienced and unrecalled pain are unknown. 

Respiratory depression is the most important adverse event to consider during propofol use. Supplemental oxygen is commonly coadministered with propofol to prolong normal oxygenation if respiratory depression or apnea develop. 

For the full article, please visit www.pharmacytoday.org for the May 2019 issue of Pharmacy Today.