[The author responds:]

Letters

CJEM 2002;4(1):3-6

I thank Dr. Sullivan for his comments, and am encouraged by his endorsement of mini-dose titration of propofol. I need to correct him in his misunderstanding of my comments about patient-controlled sedation. I did not suggest, nor would I, that infusions of propofol in the order of 16-33 mg/min be used. The study quoted¹ showed that patients giving themselves such doses every minute by pushing on a button could not sedate themselves to the point of deep sedation (i.e., loss of protective reflexes). This study was quoted to demonstrate the safety of the mini-dose approach and was not meant to encourage ongoing infusions.

I am otherwise heartened by this positive input from Anesthesia, and encourage all emergency departments who are hoping to initiate safe procedural sedation policies to work with their anesthesia and emergency colleagues to establish standardized practices.

Jim Ducharme, MD 
Clinical Director 
Emergency Medicine 
Atlantic Health Sciences Corporation 
Saint John, NB

Reference

1. Smith AF, Thorpe SJ, Cook LB. Patient-controlled sedation using propofol: randomized, double-blind dose refinement. Eur J Anaesthesiol 1999;15:18-22.