Recall Incidence After Procedural Sedation With Propofol in Emergency Departments

Propofol is widely used in emergency departments to facilitate painful procedures, but the incidence of recall in this context is not well understood.

Assess the frequency of recall following a propofol-based procedural sedation protocol used in emergency departments.

This prospective, multicenter study included consenting adult patients undergoing procedural sedation with propofol. Sedation was induced in patients requiring procedural sedation for fracture or joint dislocation reduction using propofol titrated to the loss of eyelash reflex and lack of responsiveness to stimuli. Two hours after recovery, the patients were asked about immediate recall using a validated questionnaire. A follow-up telephone call the next day assessed delayed recall. Satisfaction with the sedation was recorded on a 10-cm visual analogue scale.

A total of 248 patients (161 males, 65%) were enrolled and assessed 2 hours after recovery, with 176 patients completing follow-up at 24 hours. In response to the question, "Can you remember anything between the start of procedural sedation and waking?," 39 of the 248 patients (16%, 95% CI: 12.0-20.0%) reported recalling something 2 hours after recovery. At telephone follow-up, 33 of the 175 patients (18.9%, 95% CI: 14.0-26.0%) reported recalling something. The satisfaction rate, measured using an analogue scale (0-100), was higher in the absence of recall (mean ± SD: 95 ± 15 vs. 83 ± 33; p = 0.01).

In this study, recall following procedural sedation with propofol was common among adults. However, this phenomenon appeared to have only a mild impact on patient satisfaction.

Clinical Trials.gov identifier: NCT02200744.