Propofol versus midazolam for procedural sedation in the emergency department: A study on efficacy and safety

Heleen Lameijer, Ytje T. Sikkema, Albert Pol, Maike G. E. Bosch, Femke Beije, Rieneke Feenstra, Bas W. J. Bens, Ewoud ter Avest*

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

    11 Citations (Scopus)


    Background: Procedural sedation for painful procedures in the emergency department (ED) can be accomplished with various pharmacological agents. The choice of the sedative used is highly dependent on procedure- and patient characteristics and on personal- or local preferences.

    Methods: We conducted a multicenter retrospective cohort study of procedural sedations performed in the EDs of 5 hospitals in the Netherlands over a 4 year period to evaluate the efficacy- (success rate of the intended procedure) and safety (incidence of sedation (adverse) events) of propofol sedations compared to midazolam sedations.

    Results: A total of 592 ED sedations were included in our study. Patients sedated with propofol (n = 284, median dose 75 mg) achieved a deeper level of sedation (45% vs. 25% deep sedation, p <0.001), had a higher procedure success rate (92% vs. 81%, p <0.001) and shorter median sedation duration (10 vs. 17 min, p <0.001) compared to patients receiving midazolam (n = 308, median dose 4 mg). A total of 112 sedation events were registered for 99 patients. Transient apnea was the most prevalent event (n = 73), followed by oxygen desaturation (n = 18) airway obstruction responsive to simple maneuvers (n = 13) and hypotension (n = 6). Propofol sedations were more often associated with the occurrence of apnea's (20% vs. 10%, p = 0.004), whereas clinically relevant oxygen desaturations (

    Conclusion: Propofol is more effective and at least as safe as midazolam for procedural sedation in the ED. (C) 2017 Elsevier Inc. All rights reserved.

    Original languageEnglish
    Pages (from-to)692-696
    Number of pages5
    JournalAmerican journal of emergency medicine
    Issue number5
    Publication statusPublished - May-2017


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