The use of propofol target-controlled sedation in emergency department procedural sedation

Burton, Fiona Marie (2023) The use of propofol target-controlled sedation in emergency department procedural sedation. MD thesis, University of Glasgow.

Abstract

Background

Procedural sedation (PS) is commonly required in the Emergency Department (ED). Propofol is a drug commonly used for this. It is administered as an intravenous bolus and adverse events can occur. Target-controlled infusion (TCI) is another way of administering Propofol and may produce less adverse events as the concentration is targeted to be within the therapeutic window. TCI is not currently used in the ED. I assessed the feasibility of running an RCT comparing Propofol TCI vs bolus administration in the ED.

Methods

I assessed feasibility of a future RCT by; conducting a survey to describe current local PS practice, a time to set up TCI study, a systematic review of rate of adverse events for Propofol TCI vs bolus in PS and a multicentre single arm feasibility study on Propofol TCI in ED sedation.

Results

112 respondents completed the survey; most respondents experienced a complication during PS and 79% of respondents were comfortable using Propofol. The difference in median set up time of TCI vs bolus was 143 seconds, approximately half of what participants felt was acceptable. There is a paucity of studies involving TCI in the ED. Twenty-five patients were recruited to the study and results suggests a trend towards fewer respiratory and hypotensive events with Propofol TCI versus other methods of administration. No adverse events were recorded. TCI was deemed acceptable by patients and staff.

Conclusion

Although results indicate that an RCT to compare the incidence of adverse events in ED procedural sedation would be technically feasible, there may be more efficient approaches to achieving a safe change in practice.

• Item Type: Thesis (MD)
• Qualification Level: Doctoral
• Subjects: R Medicine > R Medicine (General)
• Colleges/Schools: College of Medical Veterinary and Life Sciences
• Supervisor's Name: Sim, Professor Malcolm and Walters, Professor Matthew
• Date of Award: 2023
• Depositing User: Theses Team
• Unique ID: glathesis:2023-83944
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 15 Nov 2023 12:38
• Last Modified: 15 Nov 2023 14:05
• Thesis DOI: 10.5525/gla.thesis.83944
• URI: https://theses.gla.ac.uk/id/eprint/83944

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