Other Agents

Propofol is an ultrashort-acting intravenous anesthetic marketed in the United States as Diprivan. It has been reported as a safe and effective nonanesthetic sedative for adults undergoing fracture reduction, reduction of joint dislocations, minor surgical procedures (I&D of abscesses), cardioversion, and chest tube placement in the ED.21 It has been used in children in the ED for difficult fracture reduction, incarcerated inguinal hernia reductions, and cardioversion, although there are no published reports. Propofol's onset of action occurs within seconds and its duration of action is extremely short, requiring continuous infusion for maintenance of clinical effects. After discontinuation of the drug in sedative doses, patients are usually awake and responsive within minutes. It does not possess any analgesic properties in sedative doses and must be used in conjunction with narcotics for painful procedures. Propofol has potent dose-related respiratory depressant effects, may quickly result in deep sedation, and may produce hypotension. More experience is needed before it can be recommended for routine use in children in the ED.

In the past, the "DPT cocktail," consisting of Demerol (meperidine), Phenergan (promethazine), and Thorazine (chlorpromazine), was a popular sedative/analgesic choice for children in the emergency department. Unfortunately, the intramuscular route does not allow for titration of effects and its onset of action is variable. The wide range of doses used and combination of three sedatives adds to confusion and potential for serious respiratory depression. In addition, the efficacy of this "cocktail" can be variable while its duration of action can be several hours, not making it a preferable choice for sedation in the ED. 22

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