110 range, anesthetists object to its use in the emergency and other departments [25]. However, Zed et al. and Sipe et al. have shown that a bolus dose of 1 mg/kg followed by 0.5 mg/kg (when it is necessary) may reduce both the hypoxia and apnea compared to the 1.5 mg/kg dose [26, 27]. This randomized controlled trial study was initiated primarily to determine the safety of PSA delivery in the ED setting. In addition, this study also aimed to evaluate the safety profile and effectiveness of the two sedative hypnotics, namely propofol and midazolam, which have been commonly used in patients undergoing PSA. Non- parametric analysis of data was applied in this study because of the small sample size and non-Gaussian distribution in descriptive analysis. Two tests were applied throughout, namely the Mann-Whitney U test (chi-square) and Kruskal-Wallis (chi-square and P value). The data were further analyzed as non-stratified to see the effect without the confounder, for example, the sex of subjects in the study and later the stratified analysis where the confounders were controlled. In this study, age could not be stratified because the subjects recruited were adults. This trial, which took 1 year to complete, involved 40 subjects who fully consented to participate. There were no drop-outs. Clear instructions and guidelines were strictly adhered to in order to minimize bias as well as errors in evaluating the safety profile and efficacy between the two drugs used in PSA. A standard set of forms was utilized, and all relevant information required for the study has been clearly documented. This study did not show remarkable differences between the two drugs used, namely propofol and midazolam in PSA. Both drugs have been found to be safe for use and did not cause any serious adverse side effects, such as hypoventilation, hypotension, apnea, hypoxia or allergic reactions. None of the patients involved in this study developed any complications throughout the process of procedural sedation. These findings were consistent and supported the study done by Hasen et al. on PSA using intravenous propofol for 48 patients undergoing elective orthopedic surgery under regional blockade [28]. They firmly concluded that propofol is a safe and effective drug to be used in PSA with no respiratory or cardiovascular depression, or other undesirable adverse effects. Cheol et al., who conducted a randomized double-blind comparative study using propofol alone and combined propofol and midazolam for colonoscopy, found that both propofol alone and combined propofol and midazolam are safe and effective [29]. However, some results found in this trial remained significant and may illustrate the relevant direction of the future use of these drugs in the emergency department setting. Int J Emerg Med (2010) 3:105–113 Changes in blood pressure recorded during procedural sedation There was a significant and relevant variation in blood pressure before, during and after the procedure. It was found in this study that propofol caused a marked reduction in both the systolic and diastolic blood pressures during the procedure when compared to midazolam. Systolic blood pressure dropped from a mean (SD) of 134.00 mmHg (16.27) to 115.50 mmHg (10.50), while the diastolic blood pressure dropped from a mean (SD) of 75.30 mmHg (9.27) to 65.00 mmHg (8.66) intra-procedure. After the procedure ended, the systolic and diastolic blood pressures normalized to the pre-procedural value (SD) 122.5 mmHg (13.43). The midazolam group on the other hand showed a marked elevation in both systolic and diastolic blood pressures when the procedure was carried out. Prior to the procedure the mean systolic blood pressure was 121.00 mmHg (17.59) and increased to 131.50 mmHg (15.31) intra-procedure, then normalized with the comple- tion of the procedure. A similar observation was seen in the diastolic blood pressure. The different blood pressure responses can be explained by the different pharmacody- namics of the two drugs. Propofol is known to affect the cardiovascular function of the body system, in particular compromising the blood pressure mainly through the vasodilation effect, whereas benzodiazepine is commonly known to depress more of the respiratory function. Effects on mean arterial pressure In this study both propofol and midazolam did not have a significant effect on the mean arterial pressure when a procedure was carried out to completion. Despite the changes in MAP in both drugs under study, during the procedure the p value showed non-statistical significance (p=0.774). Both drugs did not result in changes of perfusion to various organs in the body, further confirming the safety of both drugs. Effects on respiratory rate Both propofol and midazolam showed no difference in respiratory rate during and after procedures (p =0.106). This could be due to the appropriate titration dose technique used for the procedural sedation. Effects on heart rate There was a slight reduction of heart rate recorded in this trial during the procedure in the propofol group with a mean value of 76.40 (16.37), while the pre-procedure mean heart rate (SD) was 83.55 (16.3). The heart rate reduced slightly after the completion of the procedure, but did not