Kaye Philip, Govier Matthew
Emergency Department, Royal United Hospital, Bath, UK.
Anaesthetic Department, Royal United Hospital, Bath, UK.
Emerg Med J. 2014 Nov;31(11):904-8. doi: 10.1136/emermed-2013-202742. Epub 2013 Jul 29.
Many emergency patients present with cardiac arrhythmias requiring emergency direct current countershock cardioversion (DCCV) as a part of their management. Almost all require sedation to facilitate the procedure. Propofol has been used for procedural sedation in Emergency Medicine since 1995. In 1996, in a review article in Anaesthesia, it was recommended as the drug which most closely approaches the ideal agent for DCCV. However, the existing evidence for the dosage requirements and safety of propofol in emergency DCCV is limited. We report a prospective case series of patients who underwent sedation-facilitated DCCV using propofol in the emergency department with both sedation and DCCV delivered by emergency physicians. The results indicate propofol is a safe drug for procedural sedation to facilitate emergency DCCV in patients with an atrial tachyarrhythmia without any evidence of haemodynamic compromise. A dose of 1 mg/kg appears to be safe in the majority of these patients. Using the adverse event reporting tool produced by the World SIVA International Sedation Task Force there were no moderate or sentinel adverse events in these patients. A reduced dose should be considered in older patients to prevent transient complications. Propofol at a dose of 0.5 mg/kg appears to be a safe drug for procedural sedation to facilitate emergent or urgent DCCV in patients with an atrial tachyarrhythmia with evidence of haemodynamic compromise. There were no sentinel adverse events associated with its use. Evidence to support the use of propofol to facilitate emergency DCCV for ventricular tachycardia is limited.
许多急诊患者会出现心律失常，需要进行紧急直流电复律（DCCV）作为治疗的一部分。几乎所有患者都需要镇静以利于该操作。自1995年以来，丙泊酚一直用于急诊医学中的操作镇静。1996年，在《麻醉学》的一篇综述文章中，它被推荐为最接近DCCV理想药物的药物。然而，关于丙泊酚在急诊DCCV中的剂量要求和安全性的现有证据有限。我们报告了一组前瞻性病例系列，这些患者在急诊科接受了使用丙泊酚的镇静辅助DCCV，镇静和DCCV均由急诊医生实施。结果表明，丙泊酚是一种安全的药物，可用于在无任何血流动力学不稳定证据的房性快速心律失常患者中进行操作镇静以利于紧急DCCV。在大多数这些患者中，1mg/kg的剂量似乎是安全的。使用世界SIVA国际镇静工作组制作的不良事件报告工具，这些患者中没有中度或严重不良事件。老年患者应考虑减少剂量以预防短暂并发症。0.5mg/kg剂量的丙泊酚似乎是一种安全的药物，可用于在有血流动力学不稳定证据的房性快速心律失常患者中进行操作镇静以利于紧急或急诊DCCV。使用该药物未出现严重不良事件。支持使用丙泊酚促进室性心动过速紧急DCCV的证据有限。
