Article ; Online: Pharmacological agents for procedural sedation and analgesia in the emergency department and intensive care unit: a systematic review and network meta-analysis of randomised trials.
British journal of anaesthesia
2024 Volume 132, Issue 3, Page(s) 491–506
Abstract: Background: We aimed to evaluate the comparative effectiveness and safety of various i.v. pharmacologic agents used for procedural sedation and analgesia (PSA) in the emergency department (ED) and ICU. We performed a systematic review and network meta- ... ...
| Abstract | Background: We aimed to evaluate the comparative effectiveness and safety of various i.v. pharmacologic agents used for procedural sedation and analgesia (PSA) in the emergency department (ED) and ICU. We performed a systematic review and network meta-analysis to enable direct and indirect comparisons between available medications. Methods: We searched Medline, EMBASE, Cochrane, and PubMed from inception to 2 March 2023 for RCTs comparing two or more procedural sedation and analgesia medications in all patients (adults and children >30 days of age) requiring emergent procedures in the ED or ICU. We focused on the outcomes of sedation recovery time, patient satisfaction, and adverse events (AEs). We performed frequentist random-effects model network meta-analysis and used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to rate certainty in estimates. Results: We included 82 RCTs (8105 patients, 78 conducted in the ED and four in the ICU) of which 52 studies included adults, 23 included children, and seven included both. Compared with midazolam-opioids, recovery time was shorter with propofol (mean difference 16.3 min, 95% confidence interval [CI] 8.4-24.3 fewer minutes; high certainty), and patient satisfaction was better with ketamine-propofol (mean difference 1.5 points, 95% CI 0.3-2.6 points, high certainty). Regarding AEs, compared with midazolam-opioids, respiratory AEs were less frequent with ketamine (relative risk [RR] 0.55, 95% CI 0.32-0.96; high certainty), gastrointestinal AEs were more common with ketamine-midazolam (RR 3.08, 95% CI 1.15-8.27; high certainty), and neurological AEs were more common with ketamine-propofol (RR 3.68, 95% CI 1.08-12.53; high certainty). Conclusion: When considering procedural sedation and analgesia in the ED and ICU, compared with midazolam-opioids, sedation recovery time is shorter with propofol, patient satisfaction is better with ketamine-propofol, and respiratory adverse events are less common with ketamine. |
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| MeSH term(s) | Adult ; Child ; Humans ; Propofol/adverse effects ; Midazolam/adverse effects ; Ketamine/adverse effects ; Network Meta-Analysis ; Pain/drug therapy ; Analgesics, Opioid/therapeutic use ; Analgesia ; Emergency Service, Hospital ; Intensive Care Units ; Conscious Sedation/adverse effects ; Conscious Sedation/methods ; Randomized Controlled Trials as Topic |
| Chemical Substances | Propofol (YI7VU623SF) ; Midazolam (R60L0SM5BC) ; Ketamine (690G0D6V8H) ; Analgesics, Opioid |
| Language | English |
| Publishing date | 2024-01-06 |
| Publishing country | England |
| Document type | Meta-Analysis ; Systematic Review ; Journal Article ; Review |
| ZDB-ID | 80074-0 |
| ISSN | 1471-6771 ; 0007-0912 |
| ISSN (online) | 1471-6771 |
| ISSN | 0007-0912 |
| DOI | 10.1016/j.bja.2023.11.050 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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