Maryam Massaeli - Assistant Professor, Department of Emergency Medicine, AJA University of Medical Sciences, Tehran, Iran
Soheil Nasouhi - Assistant Professor, Department of Emergency Medicine, AJA University of Medical Sciences, Tehran, Iran
Masoud Shahabian - Department of Emergency Medicine, AJA University of Medical Sciences, Tehran, Iran
Afsin Motallebzadeh - Anesthetist Nurse, Department of cardiac surgery, Razavi hospital, Mashhad, Iran

Background and Aim : Procedural sedation and analgesia (PSA) is one of the most importanttechniques in the emergency department (ED) that it have several protocols. The purpose of thisstudy was the comparison of various PSA protocols, including propofol/fentanyl,propofol/ketamine, and ketamine, based on the bispectral index system (BIS) and other criticalitems in adults with anterior shoulder dislocation (ASD) in the ED.Methods : This randomized three groups double-blinded clinical trial was conducted on 150patients with ASD in Besat General Hospital in Tehran, Iran. The sample size was considered 50individuals in each group with the administration of propofol/fentanyl (group A),propofol/ketamine (ketofol; group B), and ketamine (group C).. Before PSA, the sensor of BISmonitor was attached to the patient, and several items were compared, including the side effectsand duration of sedation, as well as BIS number before PSA and 1-5 min following that.Results : The BIS values at the 1st, 2nd, 3rd, 4th, and 5th min after PSA were not different in thethree groups. The comparison between the three groups regarding the patients’ satisfaction showedthat there was a significant difference between them (P=0.02), which was higher in the ketofolgroup. The comparison of side effects, induction time, procedure time, sedation time, and recoverytime showed no difference between the three groups (P≥0.05).Conclusion : The investigation of PSA using Propofol-Ketamine, Ketamine, andpropofol/fentanyl showed the similar frequency ofBIS valuesand adverse respiratory events. Theuse of propofol/fentanyl was associated with a slightly higher incidence of hypotension. Moreover, the frequency of patients’ satisfaction was higher among the subjects in group B, compared tothose in the other groups.

Procedural sedation and analgesia, Bispectral index system, Propofol, Ketamine, Fentanyl