106 immune response, and salt and water retention. In addition, these patients are extremely anxious. During these critical situations, procedures may be indicated that require patients to be subjected to some form of chemical induction to facilitate the procedure planned either to save their lives or salvage the remaining functioning organs or limbs. A collective decision needs to be made to choose the most appropriate form of chemical induction for the purpose of analgesia or sedation; usually patients receive the latter [3, 4]. The superiority of one of these drugs and the lack of potentially dangerous adverse reactions would determine the appropriate choice in the ED setting. The main goal of procedural sedation and analgesia (PSA) is to give patients some relief from both pain and anxiety with minimal adverse events. This technique has to be effective in reducing the stress response and improving patient compli- ance with a procedure [5–7]. Commonly benzodiazepine, such as diazepam or mid- azolam, is used as an agent for the PSA. Pharmacologically, it takes up to 45 min for the patients to recover fully and be discharged, and adverse events such as respiratory depres- sion are a known occurrence [8, 9]. This study examined an alternative agent to PSA, namely propofol. We already know that propofol has a similar mode of action to benzodiazepine, but with a much shorter duration of action [10]. The use of an effective short-acting drug in PSA relieves patients from numerous unpleasant side effects that are commonly seen with the use of conven- tional long-acting diazepam. We conducted a randomized controlled trial to compare the adverse events between propofol and midazolam during PSA in adult patients who attended the emergency department. The study was approved by the University Hospital Ethics and Research Committee. Objectives The purpose of the study was to compare the outcomes between a combination of fentanyl and propofol with fentanyl and midazolam on subjects during and after PSA. The outcome measurements were: 1. Vital signs: a. Systolic and diastolic blood pressure b. Respiratory rate c. Heart rate d. Mean arterial pressure (MAP) e. Oxygen saturation (SPO2) 2. End tidal carbon dioxide (EtCO2): to implement microstream capnography during PSA as a method of continuous cardiorespiratory monitoring for adverse event occurrence. Int J Emerg Med (2010) 3:105–113 Research hypothesis 1. Null hypothesis The use of combined fentanyl and propofol has no difference in adverse event occurrence over fentanyl and midazolam for PSA. 2. Population Patients who fulfill the criteria for PSA 3. Intervention Administration of either fentanyl with midazolam or fentanyl with propofol Methodology Study design This was a randomized single-blinded control trial carried out in the ED of a university hospital over a period of 12 months. The hospital is a regional tertiary referral center with an attendance rate to the emergency department exceeding 60,000 per year. It is also a teaching hospital responsible for both undergraduate student and residency- based training in many specialized fields including emer- gency medicine. The proposal for this study was presented to the Department Review Board and Hospital Ethics Committee, and we received approval to proceed. The reference for the certificate of approval is USMKK/PPSP®/ JK P&E. A short-term grant was also approved for conducting the study. All 40 patients were selected by convenience sampling, and further randomization into two groups was carried out by using the computer-generated random permuted blocks of four patients. All patients recruited did not know which drug they would receive. Each group would receive either drug A or drug B. The drugs used were single blinded. They were supplied by the pharmacy department, wrapped individually and placed in an envelope. Each envelope was sealed and labeled accordingly as drug A or drug B. The operators, emergency physicians and residents in Emergen- cy Medicine, including the main researcher, were unaware of the exact drug to be given until the envelope was opened. Administration of the medications to the patients required precise calculation of the dosage based on the subject's body weight. Inclusion criteria All adult patients who presented to the Emergency Department for either brief or intensely painful procedures,