Sedación y analgesia para procedimientos en departamentos de urgencias rurales y regionales
Procedural sedation and analgesia in rural and regional emergency departments.
Pinto RF, Bhimani M, Milne WK, Nicholson K.
Can J Rural Med. 2013 Fall;18(4):130-6.
Abstract
INTRODUCTION: Several agents can be administered during procedural sedation and analgesia (PSA) in the emergency department (ED). The purpose of this study was to determine the PSA agents commonly used by physicians working in nontertiary EDs, and to assess the physicians' comfort level administering the agents as well as their knowledge of adverse effects of the agents. METHODS: We distributed a confidential electronic survey to physicians working in nontertiary EDs in southwestern Ontario. Using a 5-point Likert scale, ED physicians were asked to rate their use of older and newer agents used for PSA in the ED, as well as their familiarity with the agents. RESULTS: A total of 55 physicians completed the survey. The most frequently used drugs were fentanyl (66.0% often or always) and propofol with fentanyl (59.2% often or always). Most respondents stated that they rarely used ketofol (54.2% rarely or never) or etomidate (77.1% rarely or never). Respondents were most comfortable using midazolam or fentanyl (96.1% somewhat or very comfortable), and least comfortable administering etomidate and ketofol (36.5% and 23.1% somewhat or very uncomfortable). These differences were magnified with comparison of physicians with CCFP (Certification in The College of Family Physicians) and CCFP(EM) (emergency medicine) designations. Additionally, etomidate's adverse effects were the least astutely recognized (19%), compared with midazolam combined with fentanyl (63%). CONCLUSION: Physicians practising in nontertiary EDs used more often, remained more comfortable with and were more familiar with older sedation agents than newer agents.
http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/cjrm/vol-18/issue-4/pdf/pg130.pdf
Ketofol versus propofol para sedación y analgesia en procedimientos en el departamento de emergencias: estudio randomizado, doble ciego
Ketamine- propofol combination (ketofol) versus propofol alone for emergency department procedural sedationand analgesia: a randomized double-blind trial.
Andolfatto G, Abu-Laban RB, Zed PJ, Staniforth SM, Stackhouse S, Moadebi S, Willman E.
Ann Emerg Med. 2012 Jun;59(6):504-12.e1-2. doi: 10.1016/j.annemergmed.2012.01.017. Epub 2012 Mar 7.
Abstract
STUDY OBJECTIVE: We determine whether a 1:1 mixture of ketamine and propofol (ketofol) for emergency department (ED) procedural sedationresults in a 13% or more absolute reduction in adverse respiratory events compared with propofol alone. METHODS: Participants were randomized to receive either ketofol or propofol in a double-blind fashion. Inclusion criteria were aged 14 years or older and American Society of Anesthesiology class 1 to 3 status. The primary outcome was the number and proportion of patients experiencing an adverse respiratory event as defined by the Quebec Criteria. Secondary outcomes were sedation consistency, efficacy, and time; induction time; and adverse events. RESULTS: A total of 284 patients were enrolled, 142 per group. Forty-three (30%) patients experienced an adverse respiratory event in the ketofolgroup compared with 46 (32%) in the propofol group (difference 2%; 95% confidence interval -9% to 13%; P=.80). Three ketofol patients and 1 propofolpatient received bag-valve-mask ventilation. Sixty-five (46%) patients receiving ketofol and 93 (65%) patients receiving propofol required repeated medication dosing or progressed to a Ramsay Sedation Score of 4 or less during their procedure (difference 19%; 95% confidence interval 8% to 31%; P=.001). Six patients receiving ketofol were treated for recovery agitation. Other secondary outcomes were similar between the groups. Patients and staff were highly satisfied with both agents. CONCLUSION: Ketofol for ED procedural sedation does not result in a reduced incidence of adverse respiratory events compared with propofol alone. Induction time, efficacy, and sedation time were similar; however, sedation depth appeared to be more consistent with ketofol.
http://download.journals.elsevierhealth.com/pdfs/journals/0196-0644/PIIS0196064412000510.pdf
Ketofol para sedación y analgesia en procedimientos en el departamento de emergencias: una revisión
Combining ketamine and propofol ("ketofol") for emergency department procedural sedation and analgesia: a review.
Arora S.
West J Emerg Med. 2008 Jan;9(1):20-3.
Emergency physicians must be comfortable and confident in providing safe and effective procedural sedation and analgesia (PSA). Goals of PSA include providing an adequate level of sedation while minimizing pain and anxiety, maximizing amnesia, minimizing the potential for adverse drug-related events, controlling behavior, and maintaining a stable cardiovascular and respiratory status. The ideal pharmacologic agent for PSA would accomplish all of these goals, and would have a quick onset and offset, be safe in all age groups, be inexpensive, and be equally efficacious in multiple routes of administration. Unfortunately, at this time no single agent exists that has all of the aforementioned qualities, so physicians must use combinations of different drugs at varying does to achieve as many of the desired goals as possible. The most recent PSA combination to be described in the literature is that of low-dose ketamine and propofol ("ketofol"). In this article we attempt to describe the postulated benefits of using these two agents together and examine the safety and efficacy of the combination.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672224/pdf/wjem-9-0020.pdf
http://escholarship.org/uc/item/6fw0c4qw#page-1
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Procedural sedation and analgesia in rural and regional emergency departments.
Pinto RF, Bhimani M, Milne WK, Nicholson K.
Can J Rural Med. 2013 Fall;18(4):130-6.
Abstract
INTRODUCTION: Several agents can be administered during procedural sedation and analgesia (PSA) in the emergency department (ED). The purpose of this study was to determine the PSA agents commonly used by physicians working in nontertiary EDs, and to assess the physicians' comfort level administering the agents as well as their knowledge of adverse effects of the agents. METHODS: We distributed a confidential electronic survey to physicians working in nontertiary EDs in southwestern Ontario. Using a 5-point Likert scale, ED physicians were asked to rate their use of older and newer agents used for PSA in the ED, as well as their familiarity with the agents. RESULTS: A total of 55 physicians completed the survey. The most frequently used drugs were fentanyl (66.0% often or always) and propofol with fentanyl (59.2% often or always). Most respondents stated that they rarely used ketofol (54.2% rarely or never) or etomidate (77.1% rarely or never). Respondents were most comfortable using midazolam or fentanyl (96.1% somewhat or very comfortable), and least comfortable administering etomidate and ketofol (36.5% and 23.1% somewhat or very uncomfortable). These differences were magnified with comparison of physicians with CCFP (Certification in The College of Family Physicians) and CCFP(EM) (emergency medicine) designations. Additionally, etomidate's adverse effects were the least astutely recognized (19%), compared with midazolam combined with fentanyl (63%). CONCLUSION: Physicians practising in nontertiary EDs used more often, remained more comfortable with and were more familiar with older sedation agents than newer agents.
http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/cjrm/vol-18/issue-4/pdf/pg130.pdf
Ketofol versus propofol para sedación y analgesia en procedimientos en el departamento de emergencias: estudio randomizado, doble ciego
Ketamine- propofol combination (ketofol) versus propofol alone for emergency department procedural sedationand analgesia: a randomized double-blind trial.
Andolfatto G, Abu-Laban RB, Zed PJ, Staniforth SM, Stackhouse S, Moadebi S, Willman E.
Ann Emerg Med. 2012 Jun;59(6):504-12.e1-2. doi: 10.1016/j.annemergmed.2012.01.017. Epub 2012 Mar 7.
Abstract
STUDY OBJECTIVE: We determine whether a 1:1 mixture of ketamine and propofol (ketofol) for emergency department (ED) procedural sedationresults in a 13% or more absolute reduction in adverse respiratory events compared with propofol alone. METHODS: Participants were randomized to receive either ketofol or propofol in a double-blind fashion. Inclusion criteria were aged 14 years or older and American Society of Anesthesiology class 1 to 3 status. The primary outcome was the number and proportion of patients experiencing an adverse respiratory event as defined by the Quebec Criteria. Secondary outcomes were sedation consistency, efficacy, and time; induction time; and adverse events. RESULTS: A total of 284 patients were enrolled, 142 per group. Forty-three (30%) patients experienced an adverse respiratory event in the ketofolgroup compared with 46 (32%) in the propofol group (difference 2%; 95% confidence interval -9% to 13%; P=.80). Three ketofol patients and 1 propofolpatient received bag-valve-mask ventilation. Sixty-five (46%) patients receiving ketofol and 93 (65%) patients receiving propofol required repeated medication dosing or progressed to a Ramsay Sedation Score of 4 or less during their procedure (difference 19%; 95% confidence interval 8% to 31%; P=.001). Six patients receiving ketofol were treated for recovery agitation. Other secondary outcomes were similar between the groups. Patients and staff were highly satisfied with both agents. CONCLUSION: Ketofol for ED procedural sedation does not result in a reduced incidence of adverse respiratory events compared with propofol alone. Induction time, efficacy, and sedation time were similar; however, sedation depth appeared to be more consistent with ketofol.
http://download.journals.elsevierhealth.com/pdfs/journals/0196-0644/PIIS0196064412000510.pdf
Ketofol para sedación y analgesia en procedimientos en el departamento de emergencias: una revisión
Combining ketamine and propofol ("ketofol") for emergency department procedural sedation and analgesia: a review.
Arora S.
West J Emerg Med. 2008 Jan;9(1):20-3.
Emergency physicians must be comfortable and confident in providing safe and effective procedural sedation and analgesia (PSA). Goals of PSA include providing an adequate level of sedation while minimizing pain and anxiety, maximizing amnesia, minimizing the potential for adverse drug-related events, controlling behavior, and maintaining a stable cardiovascular and respiratory status. The ideal pharmacologic agent for PSA would accomplish all of these goals, and would have a quick onset and offset, be safe in all age groups, be inexpensive, and be equally efficacious in multiple routes of administration. Unfortunately, at this time no single agent exists that has all of the aforementioned qualities, so physicians must use combinations of different drugs at varying does to achieve as many of the desired goals as possible. The most recent PSA combination to be described in the literature is that of low-dose ketamine and propofol ("ketofol"). In this article we attempt to describe the postulated benefits of using these two agents together and examine the safety and efficacy of the combination.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672224/pdf/wjem-9-0020.pdf
http://escholarship.org/uc/item/6fw0c4qw#page-1
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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