Protocol for Propofol Sedation in the Emergency Department
Introduction and scope
Propofol is a short‑acting intravenous sedative‑hypnotic used for procedural sedation in the ED because of its rapid onset and recovery. Its therapeutic window is narrow: the dose required for adequate sedation is close to that causing respiratory and cardiovascular depression.
Safe use requires explicit local governance, documented operator competencies, appropriate environment and equipment, and a clear rescue plan. This protocol summarises practical, exam‑relevant guidance consistent with RCEM best practice and Resuscitation Council UK standards (RCEM 2022; Resuscitation Council UK; NICE CG112; GOV.UK).
Indications and alternatives Indications
- Use propofol for adult ED procedures that require rapid, deep but short‑lived sedation where immobility is essential (for example complex orthopaedic reductions, cardioversion), provided appropriate staff, monitoring and rescue capability are immediately available.
Consider alternatives when appropriate
- Ketamine, midazolam ± opioid, or local/regional block may be preferable when airway difficulty or severe cardiorespiratory instability is predicted.
- Consider alternatives when resuscitation resources or trained staff are not immediately available.
- For children, use alternatives unless local paediatric governance specifically approves propofol use (see NICE CG112).
Comparative points
- Ketamine tends to preserve airway reflexes and supports blood pressure but may cause emergence phenomena and vomiting.