Orthopedic Disorder
Conditions
Brief summary
Procedural sedation involves the administration of sedative medications that allow patients to tolerate painful procedures. Procedural sedation has been formally recommended by experts from the French Society of Emergency Medicine (SFMU) since 2010 and procedural sedation using propofol in emergency departments has been recommended by the American College of Emergency Physicians in 2018. Propofol monotherapy is now widely used in emergency medicine (EM) in France as part of procedural sedation for performing painful procedures, however propofol has no analgesic properties per se . Pupilometry makes it possible to study the depth of analgesia by evaluating the body's nociceptive response via the ANS by studying the pupil diameter. This technique would allow the evaluation of the analgesia level in patients sedated by PROPOFOL during the realization of painful procedures. Variations in pupil diameter during painful procedures under procedural sedation in an emergency department will be assesed in this study. Secondly, patients satisfaction following the procedure will also be evaluated by the use of the French version of the ISAS-F, the Iowa Satisfaction with Anesthesia Scale.
Interventions
OTHERPupilometric evaluation
Pupilometric evaluation under procedural sedation with propofol
Sponsors
Centre Hospitalier Universitaire de Nice
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients * patient admitted at vital emergency room, * patient with an orthopedic trauma, * patient under procedural sedation with PROPOFOL.
Exclusion criteria
* Patient's refusal of pupilometry measurement. * Pre-existing pupil abnormalities. * history of pathologies with dysautonomic impairment (advanced diabetes, systemic amyloidosis, multiple sclerosis, uncontrolled hypertension, ...). * Recent administration of Metoclopramide, Droperidol, Clonidine, Dexmedetomidine * Nitrous oxide prior to procedural sedation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| pupil dilation reflex | up to 10 minutes | Amplitude of pupil dilation reflex (PRD, in % change in pupil diameter) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pupil diameter variation using the Algiscan | up to 10 minutes | Pupil diameter variation using the Algiscan device during the painful procedure. |
| Heteroevaluation of the patient's maximal pain | up to 10 minutes | Heteroevaluation of the patient's maximal pain by the doctor, caregiver or nurse using the Algoplus scale (from 0 to 5) during the painful procedure. |
| Patient's minimal Ramsay score | up to 10 minutes | Patient's minimal Ramsay score (from 0 to 6) during painful procedure |
| Pupil diameter using the Algiscan device | up to 10 minutes | Pupil diameter using the Algiscan device during the painful procedure. |
| Patient satisfaction | up to 10 minutes | Patient satisfaction as evaluated by the study questionnaire When patients are fully awaked |
| feasibility of the measurement | up to 10 minutes | Assessment of the feasibility of the measurement by the personnel who carried out the pupilometry measurement. |
| Level of sedation | up to 10 minutes | Level of sedation (qCON consciousness index)as continuously measured by the Conox® device |
Countries
France
Outcome results
None listed