A study protocol for a feasibility study: Propofol Target-Controlled Infusion in Emergency Department Sedation...

Area of Science:

• Emergency Medicine
• Anesthesiology
• Pharmacology

Background:

• Procedural sedation is crucial for emergency physicians, with propofol bolus administration common in UK EDs.
• Propofol bolus sedation offers rapid effects but risks airway compromise and apnea.
• Target-controlled infusion (TCI) propofol allows precise titration, potentially reducing adverse events, but is not standard in EDs.

Purpose of the Study:

• To assess patient acceptability of propofol TCI for procedural sedation.
• To determine recruitment rates for a future randomized controlled trial (RCT).
• To evaluate the feasibility of implementing propofol TCI in emergency departments.

Main Methods:

• Feasibility study conducted in four UK emergency departments.
• Recruited patients (18-65 years) with anterior shoulder dislocation, fasted ≥90 min, and weighing ≥50 kg.
• Sedation for shoulder reduction using propofol TCI; primary endpoint: patient satisfaction; secondary endpoints: adverse events, reduction attempts, pain scores, time to sedation.

Main Results:

• The study aimed to demonstrate patient acceptability and adequate recruitment for a future RCT.
• Data on patient satisfaction, adverse events, and procedural success were collected.
• Nursing opinions and patient-reported pain scores were also assessed.

Conclusions:

• Patient acceptability and adequate recruitment are key to proceeding with a full RCT.
• If feasible, this study supports further investigation into propofol TCI versus bolus administration.
• This research could pave the way for safer procedural sedation in emergency settings.