Sedación con propofol

Comparación de la capnometría vs. oximetría de pulso durante sedación y analgesia en aire ambiente para procedimientos A comparative evaluation of capnometry versus pulse oximetry during procedural sedation and analgesia on room air. Sivilotti ML, Messenger DW, van Vlymen J, Dungey PE, Murray HE. Departments of Emergency Medicine, Queen's University, Kingston, Ontario, Canada. marco.sivilotti@queensu.ca CJEM. 2010 Sep;12(5):397-404. Abstract OBJECTIVE: Important questions remain regarding how best to monitor patients during procedural sedation and analgesia (PSA). Capnometry can detect hypoventilation and apnea, yet it is rarely used in emergency patients. Even the routine practice of performing preoxygenation in low-risk patients is controversial, as supplementary oxygen can delay the detection of respiratory depression by pulse oximetry. The purpose of this study was to determine whether the capnometer or the pulse oximeter would first detect respiratory events in adults breathing room air. METHODS: During a randomized clinical trial comparing fentanyl with low-dose ketamine for PSA with titrated propofol, patients were monitored using pulse oximetry and continuous oral-nasal sampled capnography. Supplemental oxygen was administered only for oxygen desaturation. Sedating physicians identified prespecified respiratory events, including hypoventilation (end-tidal carbon dioxide > 50 mm Hg, rise of 10 mm Hg from baseline or loss of waveform) and oxygen desaturation (pulse oximetry < 92%). These events and their timing were corroborated by memory data retrieved from the monitors. RESULTS: Of 63 patients enrolled, 57% (36) developed brief oxygen desaturation at some point during the sedation. All responded to oxygen, stimulation or interruption of propofol. Measurements of end-tidal carbon dioxide varied substantially between and within patients before study intervention. Hypoventilation (19 patients, 30%) was only weakly associated with oxygen desaturation (crude odds ratio 1.4 [95% confidence interval 0.47 to 4.3]), and preceded oxygen desaturation in none of the 12 patients in whom both events occurred (median lag 1:50 m:ss [interquartile range 0:01 to 3:24 m:ss]). CONCLUSION: During PSA in adults breathing room air, desaturation detectable by pulse oximeter usually occurs before overt changes in capnometry are identified. http://www.cjem-online.ca/sites/default/files/pg397_1.pdf l ¿Es seguro utilizar propofol en el departamento de emergencias? Estudio randomizado controlado comparando propofol y midazolam Is it safe to use propofol in the emergency department? A randomized controlled trial to compare propofol and midazolam. Rahman NH, Hashim A. Int J Emerg Med. 2010 Mar 25;3(2):105-13. Abstract BACKGROUND: This study examined the safety and effectiveness of the procedural sedation analgesia (PSA) technique carried out in the emergency department (ED) of a university hospital over a period of 1 year. The research was done to compare the effectiveness and efficacy of moderate sedation of fentanyl combined with either midazolam or propofol for any brief, intense procedure in the ED setting. AIMS: The objectives were to observe the occurrence of adverse events in subjects undergoing PSA for intense and painful procedures in the emergency department and to implement the use of capnography as a method of monitoring the patients when they were under PSA. METHODS: Forty patients were selected for this study. They were randomly divided into two equal groups using the computer-generated random permuted blocks of four patients. Twenty patients were grouped together as group A and the remaining 20 patients as group B. Drugs used were single blinded to prevent any bias. Drug A was propofol and fentanyl, while drug B was midazolam and fentanyl. The procedures involved included orthopedic manipulation such as reduction of fractures, reduction of dislocated joints, abscess drainage, wound debridement, laceration wound repair and cardioversion. All of the subjects were monitored for their vital signs and end tidal carbon dioxide level every 10 min till the PSA was completed. The duration of stay in the ED was documented when the subjects had completed the procedure and were released from the department. RESULT: Of the study population, 75.6% were males. The mean age was 37.8 years (95% CI 33.2, 39.8). None of the patients developed any major complications while under PSA. The vital signs pre-, intra- and post-procedure were not significantly different in either the propofol or mizadolam groups (p value >0.05). CONCLUSION: This study had proven that there was no difference in adverse event occurrence between the studied drugs during PSA. Propofol can be recommended for use in PSA if the operator is well trained and familiar with the drug. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2885259/pdf/12245 _2010_Article_162.pdf     ¿Uso de propofol para sedación o sedación para uso de propofol?  Propofol use for sedation or sedation for propofol use? Duk-Kyung Kim J Anesth 2011. DOI 10.1007/s00540-011-1275-4 Abstract A large amount of pharmacological and clinical evidence supports the abuse potential of propofol. Although previous case reports have indicated that recreational use of propofol is primarily by medical professionals, its spread among the general public has recently been highlighted. This is the first case report to show that cravings for propofol can be quite intense in some people, and thus propofol can be wrongfully used by clinicians who are enticed by the promise of monetary gain. Illicit diversion of propofol in hospitals has been confirmed; thus, propofol has been designated as a controlled substance in South Korea as of February 2011. http://www.springerlink.com/content/q13l64x6753l2636/fulltext.pdf

Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org