College of Pharmacy, Qatar University, Doha, Qatar.
Ann Pharmacother. 2013 Jun;47(6):856-68. doi: 10.1345/aph.1R743. Epub 2013 May 21.
To evaluate the efficacy and safety of propofol compared to other agents for procedural sedation of adults in the emergency department (ED) and to review the use of opioids in conjunction with propofol for procedural sedation in the ED.
PubMed (1949-December 2012) and EMBASE (1980-December 2012) were searched using combinations of the following search terms: (procedural sedation or conscious sedation [MESH]) and propofol. A manual search of references was also performed.
English-language, full reports of randomized controlled trials (RCTs) and observational studies evaluating propofol use in adults undergoing procedural sedation in the ED were included if they reported efficacy or safety outcomes. Two reviewers independently assessed each article for inclusion, data extraction, and study limitations.
Thirteen RCTs and 20 observational studies meeting our inclusion criteria were retrieved. Regardless of the agent used for sedation, pro ce du ral success was greater than 80% and most trials demonstrated no statistically significant difference in the incidence of respiratory depression with propofol compared to alternatives. One RCT showed a significantly greater percent decrease in systolic blood pressure from baseline in those who received propofol compared to ketamine. Where reported, no significant difference was found in patient recall, pain, and satisfaction when opioids were added to propofol com pared to propofol alone; the addition of opioids may have resulted in a higher incidence of respiratory adverse events.
Propofol for procedural sedation is a reasonable alternative for use in the ED, with comparative efficacy and safety to other alternatives. Use of opioids in addition to propofol may not provide added benefit but does contribute to increased rates of adverse events.
评估丙泊酚相较于其他药物在急诊科（ED）成人程序镇静中的疗效和安全性，并综述在 ED 中联合应用阿片类药物进行程序镇静时丙泊酚的使用情况。
在 PubMed（1949 年-2012 年 12 月）和 EMBASE（1980 年-2012 年 12 月）中，使用以下检索词的组合进行检索：（程序镇静或清醒镇静[MeSH]）和丙泊酚。还进行了手动检索参考文献。
如果报告了疗效或安全性结果，我们纳入了评估丙泊酚在急诊科接受程序镇静的成人中应用的随机对照试验（RCT）和观察性研究的英文全文报告。两位审查员独立评估了每篇文章的纳入、数据提取和研究局限性。
共检索到符合我们纳入标准的 13 项 RCT 和 20 项观察性研究。无论镇静剂使用何种药物，程序成功率均大于 80%，且大多数试验显示与替代药物相比，丙泊酚的呼吸抑制发生率无统计学显著差异。一项 RCT 显示，与氯胺酮相比，接受丙泊酚的患者收缩压从基线的百分比下降明显更大。当阿片类药物与丙泊酚联合使用时，与单独使用丙泊酚相比，报告的患者回忆、疼痛和满意度没有显著差异；阿片类药物的添加可能导致呼吸不良事件发生率更高。
丙泊酚用于程序镇静是 ED 中一种合理的替代选择，与其他替代药物相比具有相当的疗效和安全性。除了丙泊酚之外联合应用阿片类药物可能不会带来额外益处，但会导致不良事件发生率增加。
