Propofol for procedural sedation in children in the emergency department

Ann Emerg Med. 2003 Dec;42(6):773-82. doi: 10.1016/s0196-0644(03)00619-x.


Study objective: We determine the safety and efficacy of propofol sedation for painful procedures in the emergency department (ED).

Methods: A consecutive case series of propofol sedations for painful procedures in the ED of a tertiary care pediatric hospital from July 2000 to July 2002 was performed. A sedation protocol was followed. Propofol was administered in a bolus of 1 mg/kg, followed by additional doses of 0.5 mg/kg. Narcotics were administered 1 minute before propofol administration. Adverse events were documented, as were the sedation duration, recovery time from sedation, and total time in the ED.

Results: Three hundred ninety-three discrete sedation events with propofol were analyzed. Procedures consisted of the following: fracture reductions (94%), reduction of joint dislocations (4%), spica cast placement (2%), and ocular examination after an ocular burn (0.3%). The median propofol dose was 2.7 mg/kg. Ninety-two percent of patients had a transient (<or=2 minutes) decrease in systolic blood pressure without clinical signs of poor perfusion. Nineteen (5%) patients had hypoxia, 11 (3%) patients required airway repositioning or jaw-thrust maneuvers, and 3 (0.8%) patients required bag-valve-mask ventilation. No patient required endotracheal intubation.

Conclusion: Propofol sedation is efficacious and can be used safely in the ED setting under the guidance of a protocol. Transient cardiopulmonary depression occurs, which requires vigilant monitoring by highly skilled practitioners. Propofol is well suited for short, painful procedures in the ED setting.

Publication types

  • Clinical Trial

MeSH terms

  • Adjuvants, Anesthesia / administration & dosage
  • Adolescent
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / adverse effects
  • Anesthetics, Combined
  • Bradycardia / chemically induced
  • Child
  • Child, Preschool
  • Clinical Protocols
  • Conscious Sedation / adverse effects
  • Conscious Sedation / methods*
  • Conscious Sedation / standards
  • Emergency Medical Services / methods*
  • Fasting
  • Female
  • Fentanyl / administration & dosage
  • Fentanyl / adverse effects
  • Fracture Fixation / methods
  • Humans
  • Hypnotics and Sedatives* / adverse effects
  • Hypotension / chemically induced
  • Hypoxia / chemically induced
  • Infant
  • Male
  • Morphine / administration & dosage
  • Morphine / adverse effects
  • Pediatrics / methods*
  • Propofol* / adverse effects
  • Prospective Studies
  • Respiration / drug effects


  • Adjuvants, Anesthesia
  • Analgesics, Opioid
  • Anesthetics, Combined
  • Hypnotics and Sedatives
  • Morphine
  • Fentanyl
  • Propofol