Implications for Decision Making
• Clear differences exist between short-acting and traditional agents. Short-acting agents are at least as effective as other regimens in terms of procedural success and clearly more
effective in terms of reduced procedure time. With the exception of etomidate, short-acting agents were associated with no additional risk of minor adverse events (AEs) (and some may argue fewer risks of AEs).
• Short-acting agents are associated with reduced costs. Propofol, etomidate, ketamine, and ketofol yield cost savings per procedure of $335.70, $301.76, $244.41, and $243.47
respectively, compared with standard therapy. Etomidate generates the greatest savings from a time and labour costing perspective, but savings associated with propofol are greater
because the differences in costs from hospitalization and AE rates more than offset the differences in labour costs.
• Opportunities for optimal usage exist. A survey of Canadian EDs revealed traditional agents are still in common usage. Opportunities may exist for the use of these agents by clinicians with less experience (e.g., rural physicians and nonphysician extenders, such as nurse practitioners and paramedics), given enough guidance or training.