Propofol Might Be Better than Midazolam for Emergency Department Procedural Sedation

From the NEJM:

In a retrospective cohort study, propofol was more effective than midazolam and just as safe.

Propofol and midazolam are each commonly used for procedural sedation in the emergency department (ED). To compare their efficacy and safety, investigators reviewed a convenience sample of procedural sedations performed at five hospitals in the Netherlands.

Of 592 patients treated, 284 received propofol (median dose, 75 mg) and 308 received midazolam (median dose, 4 mg). Those sedated with propofol were more likely to achieve deep sedation (45% vs. 25%), had a higher procedure success rate (92% vs. 81%), and had shorter median sedation duration (10 vs. 17 minutes). Apnea was more common with propofol (20% vs. 10%), but clinically relevant oxygen desaturation (<90%) was more common with midazolam (8% vs. 1%). No serious sedation-related adverse events occurred (including aspiration, laryngospasm or other airway obstruction not alleviated by simple airway maneuvers, intubation, hospitalization, or mortality).

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