112 on vital signs, EtCO2 and duration of regained consciousness—other cofounders like the clinical pro- cedures and number of doses of the drug top-up were not included in the data analysis. Recommendations This study did not detect any occurrence of hypoxemia, hypoventilation or apnea in any of the participating subjects despite evidence indicating that both propofol and mid- azolam do cause the above complications. This is because the study used appropriate doses to commence procedural sedation in the emergency department setting. As both of these drugs are safe and effective, the main researcher would like to recommend the following doses to be administered when performing PSA in the ED setting. For propofol, the recommended dose is 1 mg/kg body weight as a bolus dose followed by 0.5 mg/kg if required in a titrating dose. For midazolam, the recommended dose is 0.1 mg/kg body weight as a bolus dose followed by 0.1 mg/kg in a titrating dose when necessary. Although these drugs are regarded as safe and effective, caution is still needed to ensure avoidance and minimization of any possible com- plications. Appropriate attention must be given to all patients on PSA by continuous monitoring before, during and after the procedure has been completed. Studies have indicated that the use of supplemental oxygen could significantly reduce the magnitude of oxygen desaturation in any procedure performed when a patient is undergoing procedural sedation. This fact should be considered seriously. A capnograph is a very useful instrument to monitor the arterial partial pressure of carbon dioxide indirectly during PSA. It is a very sensitive tool for picking up these changes at very early stages of hypoventilation, and its detection accuracy is heavily supported by numerous studies world- wide. It is recommended that capnography should be used when PSA is performed in the ED setting. Early interven- tion could be instituted once abnormal partial pressure of carbon dioxide is detected. Finally, all patients planned for PSA in the ED setting must be thoroughly assessed, which involves detailed medical history taking in order to prevent the possibility of developing unexpected complications and delay in recovery after the procedure has been completed. Conclusions Both propofol and midazolam given at the recommended doses are equally safe and effective in PSA performed in the ED setting. However, a protocol and clinical guidelines Int J Emerg Med (2010) 3:105–113 for practice for PSA need to be developed to ensure this technique is safe and effective when carried out in the ED. Conflicts of interest None. References 1. Finn PJ, Plank LD, Clark MA, Connolly AB, Hill GL (1996) Progressive cellular dehydration and proteolysis in critically ill patients. Lancet 347:654–656 2. 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