Today I am joined by James Miner, MD; chief of emergency medicine at Hennepin and an amazing, prolific researcher on procedural sedation.

 

Some of Jim's Procedural Sedation Studies

* [cite source='pubmed']25441247[/cite]

* [cite source='pubmed']23701339[/cite]

* [cite source='pubmed']20624140[/cite]

* [cite source='pubmed']19845550[/cite]

* [cite source='pubmed']16997421[/cite]

* [cite source='pubmed']15692132[/cite]

Some of the Points on Jim's Method for Short Procedures in Stable Patients

* Pre-procedural analgesia rather than peri-procedural

* He uses preoxygenation and ETCO2

* In stable patietnts, he gives 1-1.5 mg/kg of propofol up front

* 30-90 sec retrograde amnesia

* Can do painful things as propofol is coming on, but not coming off

Are there patients who will need different dosing?

* The elderly may need less, especially if they have opioids on board

* Volume depleted patients will need less

* Thin patients will need more, obese patients will need less (if we dose by actual weight)

* (IBW + 1/3 of remaining weight) may be the better way to dose with the 1.5 mg/kg

The biggest mistakes

* People ignore how long it takes for the propofol to kick in, need to wait 60 sec before a 2nd dose

Cardioversion

* Jim (and I) uses Etomidate

Nasal CPAP for Procedural Sedation

* [cite source='pubmed']25455053[/cite]

Alfentanil for Procedural Sedation

Stay Tuned

Update

An article demonstrating that supplemental oxygen impairs pulse ox detection of hypoventilation (Chest 2004;126:552)

And an article on Fasting (Ann Emerg Med. 2014;63(2):247-58. PMID: 24438649)

Now on to the podcast...