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Does the sedation regimen affect adverse events during procedural sedation and analgesia in injection drug users?

Published online by Cambridge University Press:  04 March 2015

Frank Xavier Scheuermeyer ,
Gary Andolfatto ,
Hong Qian  and
Eric Grafstein
Frank Xavier Scheuermeyer*
Affiliation:
Department of Emergency Medicine, St. Paul's Hospital and the University of British Columbia, Vancouver, BC
Gary Andolfatto
Affiliation:
Department of Emergency Medicine, Lions Gate Hospital and the University of British Columbia, North Vancouver, BC
Hong Qian
Affiliation:
Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC
Eric Grafstein
Affiliation:
Department of Emergency Medicine, Mount St. Joseph's Hospital and the University of British Columbia, Vancouver, BC
*
Department of Emergency Medicine, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6; frank.scheuermeyer@gmail.com

Abstract

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Objectives:

Injection drug users (IDUs) often undergo procedural sedation and analgesia (PSA) as part of emergency department (ED) treatment. We compared adverse events (AEs) using a variety of sedation regimens.

Methods:

This was a retrospective analysis of a PSA safety audit in two urban EDs. Consecutive self-reported IDUs were identified, and structured data describing comorbidities, vital signs, sedation regimens (propofol [P], propofol-fentanyl [PF], fentanyl-midazolam [FM], ketofol [1:1 ketamine:propofol, KF], and ketamine-propofol [KP]) and AEs were collected. The primary outcome was the proportion of patients in each sedation group having an AE; the secondary outcome was the proportion of patients having a cardiovascular or respiratory AE.

Results:

Data were collected on 276 IDUs (78 P, 82 PF, 65 FM, 25 KF, and 26 KP), and 18 patients had AEs (6.5%, 95% CI 4.0–10.3). The AE rates were 0.0%, 8.5%, 9.2%, 12.0%, and 7.6%, respectively, with propofol having a significantly lower rate (Pearson coefficient 14.9, p = 0.007). The cardiovascular/respiratory AE rates were significantly different as well, with P, KP, and KF having the lowest rates (Pearson coefficient 13.3, p = 0.01).

Conclusions:

For IDU PSA, the overall AE rate was 6.5%, and propofol appeared to have a significantly lower rate.

Keywords

marginalized populationspatient safetyprocedural sedation and analgesia
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 15 , Issue 5 , September 2013 , pp. 279 - 288
Copyright
Copyright © Canadian Association of Emergency Physicians 2013

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