Propofol vs. Alfentanil for Moderate Procedural Sedation

Authors: Miner JR et al., Am J Emerg Med 2017 Apr 21;

Frequency of adverse events was similar, but fewer propofol patients reported pain or memory of the procedure.

Alfentanil is an ultrashort-acting opioid that induces analgesia for 7 to 9 minutes. In a single-blind (patient blinded), randomized, controlled trial, investigators at an urban county medical center compared alfentanil with propofol for procedural sedation when a moderate depth of sedation was targeted.

Depth of sedation was monitored by trained research assistants using the 5-point observer’s assessment of alertness/sedation (OAA/S) score (deeper sedation is indicated by a lower score). Patients received opioids for pain relief before the procedure, but the study drugs were given at least 20 minutes after the last dose. Doses were 10 µg/kg for alfentanil and 1 mg/kg for propofol, followed by additional doses of half the initial bolus every 3 to 5 minutes at physician discretion.

The trial was completed by 52 adult patients receiving alfentanil and 56 receiving propofol. Sedation was deeper with propofol than with alfentanil (2 vs. 3 points on the OAA/S), but the frequency of adverse events (the primary outcome) was similar between the two groups (20% and 23%). No serious adverse events were observed. One alfentanil patient vomited. More alfentanil patients reported pain during the procedure (48% vs. 13%) and more remembered the procedure (75% vs. 23%). Similar proportions of patients in the two groups were satisfied with their treatment during the procedure (87% and 84%).