January 2022 Virtual Journal Club – Propofol Target-Controlled Infusion in Emergency Department Sedation (ProTEDS): a multicentre, single-arm feasibility study

Author: Leia Kane, Adam Campbell, Jenny Forteath, Eve Fordyce, Euan Park / Editor: Rajesh Chatha, Robert Hirst / Codes: / Published: 27/01/2022

At TERN Education we are keen to help you learn how to critically evaluate the evidence base behind your practice. In order to do this, we have been producing monthly virtual journal club (VJC) modules on RCEMLearning since March 2021.

Welcome to this months Virtual Journal Club module. We are a small group of junior doctors working within Raigmore Hospital Emergency Department, a district general hospital and busy trauma unit serving the Highlands of Scotland. Our contributors range from Clinical Development Fellows in Trauma and Emergency Medicine, ACCS EM trainees and Higher Specialty Trainees. Our small group was delighted to utilise the legendary Fluke* for our VJC meetings and hope to make it a (very) regular occurrence!

*Editors note: this is a pub with some very fetching tartan upholstery. It is the 3rd rated Quick Bite in Inverness and has a Mega Mixed Grill which looks like entirely too much food for me.

The VJC gives you the opportunity to critically consider your practice and earn a certificate which demonstrates the new curriculum requirement to engage in critical appraisal activity. When you finish, click the link to the forum to discuss this months paper with colleagues around the country.

Interested in writing a module? We are looking to recruit regional teams to write future modules. Email us at tern.education@rcem.ac.uk.

References

  1. McKeage K, Perry CM. Propofol: a review of its use in intensive care sedation of adults. CNS Drugs. 2003; 17(4): 235-272. doi:10.2165/00023210-200317040-00003
  2. Edwards JA, Kinsella J, Shaw A, et al. Sedation for oocyte retrieval using target controlled infusion of propofol and incremental alfentanil delivered by non-anaesthetists. Anaesthesia. 2010 May;65(5):453-61.
  3. Burton FM, Lowe DJ, Millar J, Corfield AR, et al. Propofol Target-Controlled Infusion in Emergency Department Sedation (ProTEDS): a multicentre, single-arm feasibility study. Emerg Med J. 2021 Mar;38(3):205-210.
  4. Duncan R, Thakore S. (2021). Procedural Sedation. RCEMLearning [Accessed 12th January 2021].
  5. Newstead B, Bradburn S, Appelboam A, Reuben A, et al. Propofol for adult procedural sedation in a UK emergency department: safety profile in 1008 cases. Br J Anaesth. 2013 Oct;111(4):651-5.
  6. Green SM. Research Advances in Procedural Sedation and Analgesia. Ann Emerg Med. 2007; 49(1): 31-36. doi:10.1016/j.annemergmed.2006.09.020.
  7. Crawford M, Pollock J, Anderson K, Glavin R, et al. Comparison of midazolam with propofol for sedation in outpatient bronchoscopy. British Journal of Anaesthesia. 1993; 70(4): 419-22. doi:10.1093/bja/70.4.419.
  8. Leitch JA, Anderson K, Gambhir S, Millar K, et al. A partially blinded randomised controlled trial of patient-maintained propofol sedation and operator controlled midazolam sedation in third molar extractions. Anaesthesia.  2004; 59(9): 853-60. doi:10.1111/j.1365-2044.2004.03761.x
  9. Chan WH, Chang SL, Lin CS, et al. Target-controlled infusion of propofol versus intermittent bolus of a sedative cocktail regimen in deep sedation for gastrointestinal endoscopy: comparison of cardiovascular and respiratory parameters. J Dig Dis. 2014 Jan;15(1):18-26.
  10. Absalom AR, Mani V, De Smet T, Struys MMRF. Pharmacokinetic models for propofoldefining and illuminating the devil in the detail. British Journal of Anaesthesia. 2009; 103(1): 26-37. doi:10.1093/bja/aep143
  11. Burton FM, Lowe DJ, Millar JE, Corfield AR, et al. Effect of target-controlled propofol infusion to reduce the incidence of adverse events for procedural sedation in the emergency department: a systematic review. European Journal of emergency Medicine. 2020; 27(4): 253-9. doi:10.1097/MEJ.0000000000000655.
  12. Hemming K, Haines TP, Chilton PJ, Girling AJ, Lilford RJ. The stepped wedge cluster randomised trial: rationale, design, analysis, and reporting. BMJ. 2015; 350: h391. doi:10.1136/bmj.h391.

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