Muller Barbara, Michalon Arnaud, Reuillard Adrien, Holman Anne Marie, Guihard Bertrand, Combes Xavier
Emergency Department, Hôpital Felix Guyon, Saint Denis, CHU de la Réunion.
Emergency Department, Hôpital St Julien en Genevois.
Eur J Emerg Med. 2020 Dec;27(6):436-440. doi: 10.1097/MEJ.0000000000000697.
Propofol is widely used today outside the operating room to facilitate painful procedures. The objective of this retrospective study was to evaluate the frequency and type of complications related to a propofol-based procedural sedation protocol used in a French emergency department.
This retrospective study reviewed the records over a 6-year period of all patients-adults and children-who received propofol for procedural sedation according to a pre-established protocol. The frequency and type of adverse events related to this sedation were recorded. Adverse events were classified according to the World Society of Intra-Veinous Anaesthesia International Sedation Task Force as sentinel, moderate, minor, or minimal.
During the study period, 602 patients-395 adults (66%) and 207 (34%) children-received propofol. The main indications for procedural sedation were fracture (n = 327) and dislocation (n = 222) reduction, pleural drain placement (n = 34), and abscess incision (n = 12). Among the 602 consecutive cases, we identified 90 adverse events (14.9%; 95% confidence interval: 12-17.7%). These 90 events were classified as 1 sentinel (hypotension episode), 5 moderate (2 airway obstruction and 3 apnea episodes), 83 minor, and 1 minimal risk-averse events. There were no adverse outcomes.
Nearly all of the adverse events in our series were minor. In the French medical system, the use of propofol outside the operating room by non-anesthesiologist physicians for procedural sedation appears safe.
目前丙泊酚在手术室以外被广泛用于辅助进行疼痛性操作。这项回顾性研究的目的是评估在法国一家急诊科使用基于丙泊酚的程序性镇静方案相关并发症的发生率及类型。
这项回顾性研究对所有根据既定方案接受丙泊酚进行程序性镇静的成年和儿童患者的记录进行了为期6年的回顾。记录了与这种镇静相关的不良事件的发生率及类型。不良事件根据世界静脉麻醉学会国际镇静工作组的标准分为严重、中度、轻度或极小风险事件。
在研究期间，602例患者接受了丙泊酚治疗，其中395例为成年人（66%），207例为儿童（34%）。程序性镇静的主要适应证为骨折（n = 327）和脱位复位（n = 222）、胸腔引流管置入（n = 34）以及脓肿切开（n = 12）。在这602例连续病例中，我们识别出90例不良事件（14.9%；95%置信区间：12 - 17.7%）。这90例事件被分类为1例严重（低血压发作）、5例中度（2例气道梗阻和3例呼吸暂停发作）、83例轻度以及1例极小风险规避事件。没有不良结局。
我们系列中的几乎所有不良事件均为轻度。在法国医疗系统中，非麻醉科医生在手术室以外使用丙泊酚进行程序性镇静似乎是安全的。
