PMID- 38185564
OWN - NLM
STAT- MEDLINE
DCOM- 20240214
LR  - 20240214
IS  - 1471-6771 (Electronic)
IS  - 0007-0912 (Linking)
VI  - 132
IP  - 3
DP  - 2024 Mar
TI  - Pharmacological agents for procedural sedation and analgesia in the emergency 
      department and intensive care unit: a systematic review and network meta-analysis 
      of randomised trials.
PG  - 491-506
LID - S0007-0912(23)00694-3 [pii]
LID - 10.1016/j.bja.2023.11.050 [doi]
AB  - BACKGROUND: We aimed to evaluate the comparative effectiveness and safety of 
      various i.v. pharmacologic agents used for procedural sedation and analgesia 
      (PSA) in the emergency department (ED) and ICU. We performed a systematic review 
      and network meta-analysis to enable direct and indirect comparisons between 
      available medications. METHODS: We searched Medline, EMBASE, Cochrane, and PubMed 
      from inception to 2 March 2023 for RCTs comparing two or more procedural sedation 
      and analgesia medications in all patients (adults and children >30 days of age) 
      requiring emergent procedures in the ED or ICU. We focused on the outcomes of 
      sedation recovery time, patient satisfaction, and adverse events (AEs). We 
      performed frequentist random-effects model network meta-analysis and used the 
      Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) 
      approach to rate certainty in estimates. RESULTS: We included 82 RCTs (8105 
      patients, 78 conducted in the ED and four in the ICU) of which 52 studies 
      included adults, 23 included children, and seven included both. Compared with 
      midazolam-opioids, recovery time was shorter with propofol (mean difference 16.3 
      min, 95% confidence interval [CI] 8.4-24.3 fewer minutes; high certainty), and 
      patient satisfaction was better with ketamine-propofol (mean difference 1.5 
      points, 95% CI 0.3-2.6 points, high certainty). Regarding AEs, compared with 
      midazolam-opioids, respiratory AEs were less frequent with ketamine (relative 
      risk [RR] 0.55, 95% CI 0.32-0.96; high certainty), gastrointestinal AEs were more 
      common with ketamine-midazolam (RR 3.08, 95% CI 1.15-8.27; high certainty), and 
      neurological AEs were more common with ketamine-propofol (RR 3.68, 95% CI 
      1.08-12.53; high certainty). CONCLUSION: When considering procedural sedation and 
      analgesia in the ED and ICU, compared with midazolam-opioids, sedation recovery 
      time is shorter with propofol, patient satisfaction is better with 
      ketamine-propofol, and respiratory adverse events are less common with ketamine.
CI  - Copyright (c) 2023 British Journal of Anaesthesia. Published by Elsevier Ltd. All 
      rights reserved.
FAU - Sharif, Sameer
AU  - Sharif S
AD  - Department of Medicine, Division of Emergency Medicine, McMaster University, 
      Hamilton, ON, Canada; Department of Medicine, Division of Critical Care, McMaster 
      University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence 
      and Impact, McMaster University, Hamilton, ON, Canada. Electronic address: 
      sameer.sharif@medportal.ca.
FAU - Kang, Jasmine
AU  - Kang J
AD  - Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, 
      Canada.
FAU - Sadeghirad, Behnam
AU  - Sadeghirad B
AD  - Department of Health Research Methods, Evidence and Impact, McMaster University, 
      Hamilton, ON, Canada; Department of Anesthesia, McMaster University, Hamilton, 
      ON, Canada.
FAU - Rizvi, Fayyaz
AU  - Rizvi F
AD  - Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, 
      Canada.
FAU - Forestell, Ben
AU  - Forestell B
AD  - Department of Medicine, Division of Emergency Medicine, McMaster University, 
      Hamilton, ON, Canada.
FAU - Greer, Alisha
AU  - Greer A
AD  - Department of Medicine, Division of Emergency Medicine, McMaster University, 
      Hamilton, ON, Canada; Department of Medicine, Division of Critical Care, McMaster 
      University, Hamilton, ON, Canada.
FAU - Hewitt, Mark
AU  - Hewitt M
AD  - Department of Medicine, Division of Emergency Medicine, McMaster University, 
      Hamilton, ON, Canada; Department of Medicine, Division of Critical Care, McMaster 
      University, Hamilton, ON, Canada.
FAU - Fernando, Shannon M
AU  - Fernando SM
AD  - Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; 
      Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, 
      ON, Canada.
FAU - Mehta, Sangeeta
AU  - Mehta S
AD  - Department of Medicine, Sinai Health System; Interdepartmental Division of 
      Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
FAU - Eltorki, Mohamed
AU  - Eltorki M
AD  - Department of Pediatrics, Division of Pediatric Emergency Medicine, McMaster 
      University, Ottawa, ON, Canada.
FAU - Siemieniuk, Reed
AU  - Siemieniuk R
AD  - Department of Health Research Methods, Evidence and Impact, McMaster University, 
      Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, 
      Canada.
FAU - Duffett, Mark
AU  - Duffett M
AD  - Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
FAU - Bhatt, Maala
AU  - Bhatt M
AD  - Department of Medicine, Sinai Health System, Interdepartmental Division of 
      Critical Care Medicine, Toronto, ON, Canada.
FAU - Burry, Lisa
AU  - Burry L
AD  - Department of Medicine, Sinai Health System; Interdepartmental Division of 
      Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of 
      Pharmacy, Sinai Health System, Leslie Dan Faculty of Pharmacy, University of 
      Toronto, Toronto, ON, Canada.
FAU - Perry, Jeffrey J
AU  - Perry JJ
AD  - Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
FAU - Petrosoniak, Andrew
AU  - Petrosoniak A
AD  - Department of Medicine, Division of Emergency Medicine, University of Toronto, 
      Toronto, ON, Canada.
FAU - Pandharipande, Pratik
AU  - Pandharipande P
AD  - Department of Anesthesiology, Division of Critical Care, Vanderbilt University 
      School of Medicine, Nashville, TN, USA.
FAU - Welsford, Michelle
AU  - Welsford M
AD  - Department of Medicine, Division of Emergency Medicine, McMaster University, 
      Hamilton, ON, Canada.
FAU - Rochwerg, Bram
AU  - Rochwerg B
AD  - Department of Medicine, Division of Critical Care, McMaster University, Hamilton, 
      ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster 
      University, Hamilton, ON, Canada.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20240106
PL  - England
TA  - Br J Anaesth
JT  - British journal of anaesthesia
JID - 0372541
RN  - YI7VU623SF (Propofol)
RN  - R60L0SM5BC (Midazolam)
RN  - 690G0D6V8H (Ketamine)
RN  - 0 (Analgesics, Opioid)
SB  - IM
MH  - Adult
MH  - Child
MH  - Humans
MH  - *Propofol/adverse effects
MH  - Midazolam/adverse effects
MH  - *Ketamine/adverse effects
MH  - Network Meta-Analysis
MH  - Pain/drug therapy
MH  - Analgesics, Opioid/therapeutic use
MH  - *Analgesia
MH  - Emergency Service, Hospital
MH  - Intensive Care Units
MH  - Conscious Sedation/adverse effects/methods
MH  - Randomized Controlled Trials as Topic
OTO - NOTNLM
OT  - analgesia
OT  - critical care
OT  - emergency
OT  - network meta-analysis
OT  - procedural sedation
OT  - systematic review
EDAT- 2024/01/08 00:42
MHDA- 2024/02/13 06:45
CRDT- 2024/01/07 21:54
PHST- 2023/08/07 00:00 [received]
PHST- 2023/09/29 00:00 [revised]
PHST- 2023/11/30 00:00 [accepted]
PHST- 2024/02/13 06:45 [medline]
PHST- 2024/01/08 00:42 [pubmed]
PHST- 2024/01/07 21:54 [entrez]
AID - S0007-0912(23)00694-3 [pii]
AID - 10.1016/j.bja.2023.11.050 [doi]
PST - ppublish
SO  - Br J Anaesth. 2024 Mar;132(3):491-506. doi: 10.1016/j.bja.2023.11.050. Epub 2024 
      Jan 6.