The ideal sedative for patients who are undergoing cardioversion in the emergency department (ED) might be propofol (Diprivan®, AstraZeneca), according to an experience reported from Hospital Clinic in Barcelona, Spain. The drug offers a fast onset, minimal cardio-pulmonary depression, and a rapid recovery.
When researchers compared propo-fol and etomidate (Ben Venue Laboratories) and midazolam (Versed®, Roche), with or without flumazenil (e.g., Mazicon®, Roche), propofol yielded superior results. Although all four regimens were uniformly effective, patients receiving propofol experienced the shortest recoveries and the fewest adverse effects.
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The midazolam/flumazenil combination was found to be problematic when all patients, except one, became sedated again after flumazenil was discontinued.
Although etomidate offered hemo-dynamic stability, rapid sedation, and rapid recovery, it had adverse effects such as myoclonus, which can interfere with the interpretation of the electrocardiogram.