Int J Emerg Med (2010) 3:105–113 DOI 10.1007/s12245-010-0162-3 ORIGINAL RESEARCH ARTICLE Is it safe to use propofol in the emergency department? A randomized controlled trial to compare propofol and midazolam Nik Hisamuddin Nik Ab Rahman & Ahmad Hashim Received: 23 September 2009 / Accepted: 14 January 2010 / Published online: 25 March 2010 # Springer-Verlag London Ltd 2010 Abstract Background This study examined the safety and effective- ness of the procedural sedation analgesia (PSA) technique carried out in the emergency department (ED) of a university hospital over a period of 1 year. The research was done to compare the effectiveness and efficacy of moderate sedation of fentanyl combined with either mid- azolam or propofol for any brief, intense procedure in the ED setting. Aims The objectives were to observe the occurrence of adverse events in subjects undergoing PSA for intense and painful procedures in the emergency department and to implement the use of capnography as a method of monitoring the patients when they were under PSA. Methods Forty patients were selected for this study. They were randomly divided into two equal groups using the computer-generated random permuted blocks of four patients. Twenty patients were grouped together as group A and the remaining 20 patients as group B. Drugs used were single blinded to prevent any bias. Drug A was propofol and fentanyl, while drug B was midazolam and The views expressed in this paper are those of the author(s) and not those of the editors, editorial board or publisher. N. H. N. A. Rahman Consultant and Head of Emergency Medicine, PPSP, USM, Kubang Kerian, Malaysia A. Hashim Department of Emergency and Trauma, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia N. H. N. A. Rahman (*) Department of Emergency Medicine, School of Medical Sciences, USM, Kubang Kerian 16150, Malaysia e-mail: nhliza@hotmail.com fentanyl. The procedures involved included orthopedic manipulation such as reduction of fractures, reduction of dislocated joints, abscess drainage, wound debridement, laceration wound repair and cardioversion. All of the subjects were monitored for their vital signs and end tidal carbon dioxide level every 10 min till the PSA was completed. The duration of stay in the ED was documented when the subjects had completed the procedure and were released from the department. Result Of the study population, 75.6% were males. The mean age was 37.8 years (95% CI 33.2, 39.8). None of the patients developed any major complications while under PSA. The vital signs pre-, intra- and post-procedure were not significantly different in either the propofol or miz- adolam groups (p value >0.05). Conclusion This study had proven that there was no difference in adverse event occurrence between the studied drugs during PSA. Propofol can be recommended for use in PSA if the operator is well trained and familiar with the drug. Keywords Procedural sedation analgesia . Midazolam . Propofol . Emergency department Introduction Patients who attend the emergency department (ED) for any form of trauma and critically ill conditions frequently present with physical or mental pain and agitation. These stresses may be associated with tremendous neuro-humoral elevation of plasma catecholamine, cortisol, glucose, anti- diuretic hormone and acute phase protein levels [1, 2]. This elevation can cause significant tachycardia, hypertension, vasoconstriction, increase oxygen consumption, blunting of