108 Int J Emerg Med (2010) 3:105–113 Table 2 Demographic data and vital sign parameters for both treatment groups Demography/vital parameters Group A (propofol and fentanyl) Group B (midazolam and fentanyl) Number of patients Age (years) Sex: Male Female Systolic BP (mmHg) Diastolic BP (mmHg) Mean arterial pressure (mmHg) Oxygen saturation (%) End tidal CO2 (mmHg) Heart rate (per minute) Respiratory rate (per minute) Discussion 20 40.6 (95% CI 38.2, 43.3) 15 5 127.50 (95% CI 120.00, 143.75) 75.00 (95% CI 70.00, 80.00) 94.50 (95% CI 87.10, 100.00) 99.9 (95% CI 99.80, 100.00) 38.50 (95% CI 33.25, 40.00) 80.00 (95% CI 71.00, 100.00) 19.50 (95% CI 18.00, 23.50) 20 35.0 (95% CI 33.2, 37.6) 16 4 130.00 (95% CI 120.00, 140.00 70.00 (95% CI 70.00, 80.00) 93.30 (95% CI 87.10, 99.17) 100.00 (95% CI 100.00, 100.00) 36.00 (95% CI 33.25,39.00) 80.00 (95% CI 78.00, 96.50) 18.00 (95% CI 14.00, 22.00) p-value >0.05 p=0.424 p=0.705 p=0.241 p=0.093 p=0.541 p=0.286 p=0.662 p=0.776 p=0.334 The main goal of PSA is to give patients some relief from both pain and anxiety. In addition, this technique has been clinically shown to be effective in reducing the stress response and improving patient compliance with undergo- ing a procedure. In general, procedural sedation should be accompanied by analgesia simply because analgesia is able to decrease the stressful effect. This could result in a low requirement for sedatives [12]. The use of PSA has generated much interest and debate, although the technique has been widely practiced in many settings that previously were regarded as being in the domain of anesthesiology [13, 14]. PSA offers many advantages. Firstly, patients are able to maintain conscious- ness while undergoing an unpleasant procedure. Their tolerance of such painful procedures makes them able to cooperate with the care providers, thereby increasing the Table 3 Comparing propofol and midazolam by SBP, DBP and MAP Variables Systolic blood pressure Pre-procedure Intra-procedure Post-procedure Diastolic blood pressure Pre-procedure Intra-procedure Post-procedure MAP Pre-procedure Intra-procedure Post-procedure Propofol Mean (SD) 134.00 (16.27) 115.50 (10.50) 122.50 (13.43) 75.30 (9.27) 64.75 (8.66) 70.25 (6.52) 94.45 (9.88) 82.00 (8.70) 87.76 (9.41) Propofol Median (IQR) 127.50 (120.00, 143.75) 120.00 (110.00, 120.00) 120.00 (111.25, 130.00) 75.00 (70.00, 80.00) 65.00 (60.00, 70.00) 70.00 (60.00, 78.75) 94.50 (87.10, 100.00) 81.65 (76.70, 89.17) 86.70 (80.00, 92.90) compliance further. In addition, this technique does not greatly disrupt the patient’s daily activities. Upon being discharged from the hospital, the patients can resume their jobs and daily activities within a relatively short period of time with minimal discomfort. The settings found to be of benefit to patients undergoing PSA include procedures in dentistry (dental and oral surgery), radiology, medicine (bronchoscopy, endoscopy, cardiac studies, pacemaker placement) and gynecology (in vitro fertilization). This approach is also being utilized in the outpatient setting [15– 17]. In the ED, procedural sedation and analgesia have been widely indicated in overtly anxious patients undergoing procedures such as repair of complicated lacerations, reduction of fractures, application of plaster casts, incision and drainage of abscesses and wound care, thus making it a technique of choice. Despite the promising outcomes and benefits, some precautions are still required. Adverse events such as Midazolam Mean (SD) 131.50 (15.31) 121.00 (17.59) 120.75 (15.25) 75.25 (11.53) 65.75 (11.62) 73.00 (15.25) 94.66 (10.31) 83.84 (12.27) 87.73 (12.44) Midazolam Median (IQR) 130.00 (120.00, 140.00) 120.00 (110.00, 133.00) 120.00 (110.00, 128.75) 70.00 (70.00, 80.00) 67.50 (60.00, 70.00) 70.00 (61.25, 78.75) 93.30 (87.10, 99.17) 85.00 (74.97, 89.17) 86.70 (80.82, 92.25) p-value 0.679 0.388 0.608 0.731 0.868 0.989 0.765 0.744 0.733