Study designs of evaluations included in the review
Inclusion criteria were not specified in terms of the study design. However, reviews, case reports or comments were excluded. Two studies were excluded because of small patient numbers, no randomisation and no explanation of choice of drug. Randomised controlled trials (RCTs) and observational studies were included.
Specific interventions included in the review
Inclusion criteria were not specified in terms of the interventions, but it was clear that studies of propofol were to be included. The included studies used infusions or boluses of propofol (generally 1 mg/kg followed by further doses until the required level of sedation was achieved), either alone or in combination with fentanyl. Controlled trials compared propofol with methohexital, etomidate or midazolam (midazolam given either alone or in combination with ketamine or flumazenil). Cointerventions included fentanyl, morphine, unspecified opiates and oxygen; routine oxygen was not given in all studies. Studies aimed at various levels of sedation where reported, including: sufficient sedation for ptosis and slurred speech, tolerance of pain with no purposeful verbalisation or movement, Ramsay Scale score of 4 to 5, Ramsay score of 6, and bispectral analysis score of 70 to 85.
Participants included in the review
Inclusion criteria were not specified in terms of the participants, but it was clear that the review focused on studies of patients undergoing procedures in the emergency department. The included studies were in children and adults undergoing a variety of painful procedures including fracture reduction; in one study, adult patients were undergoing cardioversion. In some of the included studies the patients were fasted.
Outcomes assessed in the review
Inclusion criteria were not specified in terms of the outcomes. The included studies assessed a variety of outcomes such as depth of sedation, time to sedation, recovery and discharge, satisfaction (physician, nurse, patient and parent), patient recall and adverse events.
How were decisions on the relevance of primary studies made?
The authors did not state how the papers were selected for the review, or how many reviewers performed the selection.