Profiling adverse respiratory events and vomiting when using propofol for emergency department procedural sedation

Emerg Med Australas. 2007 Oct;19(5):405-10. doi: 10.1111/j.1742-6723.2007.00982.x.


Objectives: To evaluate the rate of adverse respiratory events and vomiting among ED patients undergoing procedural sedation with propofol.

Methods: This was a prospective, observational series of patients undergoing procedural sedation. Titrated i.v. propofol was administered via protocol. Fasting status was recorded.

Results: Four hundred patients undergoing sedation were enrolled. Of these 282 (70%, 95% confidence interval [CI] 66-75%) had eaten or drunken within 6 and 2 h, respectively. Median fasting times from a full meal, snack or drink were 7 h (interquartile range [IQR] 5-9 h), 6 h (IQR 4-8 h) and 4 h (IQR 2-6 h), respectively. Overall a respiratory event occurred in 86 patients (22%, 95% CI 18-26%). An airway intervention occurred in 123 patients (31%, 95% CI 26-35%). In 111 cases (90%, 95% CI 60-98%) basic airway manoeuvres were all that was required. No patients were intubated. Two patients vomited (0.5%, 95% CI 0.0-1.6%), one during sedation, one after patient became conversational. One patient developed transient laryngospasm (0.25%, 95% CI 0-1.2%) unrelated to vomiting. There were nil aspiration events (0%, 95% CI 0-0.74%).

Conclusions: Seventy per cent of patients undergoing ED procedural sedation are not fasted. No patient had a clinically evident adverse outcome. Transient respiratory events occur but can be managed with basic airway interventions making propofol a safe alternative for emergency physicians to provide emergent procedural sedation.

MeSH terms

  • Adolescent
  • Adult
  • Adverse Drug Reaction Reporting Systems
  • Aged
  • Conscious Sedation / adverse effects
  • Conscious Sedation / methods*
  • Emergency Service, Hospital*
  • Female
  • Health Status Indicators
  • Humans
  • Hypnotics and Sedatives / adverse effects*
  • Hypnotics and Sedatives / therapeutic use
  • Male
  • Middle Aged
  • Propofol / adverse effects*
  • Propofol / therapeutic use
  • Prospective Studies
  • Respiratory Function Tests
  • Respiratory Tract Diseases / chemically induced*
  • Risk Factors
  • Time Factors
  • Vomiting / chemically induced*


  • Hypnotics and Sedatives
  • Propofol