Propofol Infusion for the Retrieval of the Acutely Psychotic Patient


      Transporting acutely psychotic patients is hazardous because of the risks they present to themselves, escorting staff, and aircraft. Various strategies have been proposed, usually involving combinations of sedating drugs and physical restraint. Thus far, none guarantees safe retrieval while completely mitigating risks. This case proposes the use of propofol as an alternative to more traditionally used agents. An infusion facilitated the uneventful and safe retrieval of a patient who had demonstrated resistance and tolerance to other drugs. Discussion is also presented on the potential utility of propofol for the retrieval of acutely psychotic patients.
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        • Broadstock M
        The effectiveness and safety of drug treatment for urgent sedation in psychiatric emergencies. A critical appraisal of the literature.
        NZHTA Report. 2001; 4
        • National Association of EMS Physicians Position Paper
        Patient restraint in emergency medical services systems.
        PreHosp Emerg Care. 2002; 6: 340-345
      1. Department fo Human Services Mental Health Services and Programs. A new millennium, a new beginning: mental health in South Australia emergency transport of mental health consumers from country locations: policy and procedure series 2002-2005. EDM P7-02. December 2002.

      2. National Mental Health Working Group. National safety priorities in mental health: a national plan for reducing harm, Health Priorities and Suicide Prevention Branch, Department of Health and Ageing, Commonwealth of Australia, Canberra. October 2005.

        • Wheeler S
        • Wong MD, B
        • L'Heureux R
        Criteria for sedation of psychiatric patients for air transport in British Columbia.
        British Columbia Med J. 2009; 51: 346-349
        • Pierson K
        • Power Y
        • Marcus A
        • Dahlberg A
        Airline passenger misconduct: management implications for physicians.
        Aviat Space Environ Med. 2007; 78: 361-367
        • Hughes D
        Acute psychopharmacological management of the aggressive psychotic patient.
        Psychiatric Services. 1999; 50: 1135-1137
      3. Western Australian Therapeutics Advisory Group. Sedation of acutely agitated adult patients prior to transportation: a guide for medical practitioners. Version 1. January 2006.

        • Byrne P
        Managing the acute psychotic episode.
        BMJ. 2007; 334: 686-692
        • Keks N
        • Blashki G
        The acutely psychotic patient: Assessment and initial management.
        Aust Fam Physician. 2006; 35: 90-94
        • Bruce M
        • Thayer K
        Prehospital management of the psychotic and aggressive patient with bipolar disease.
        (Accessed April 2011.)
        • Muakkassa FF
        • Marley RA
        • Workman MC
        • Salvator AE
        Hospital outcomes and disposition of trauma patients who are intubated because of combativeness.
        J Trauma. 2010; 68: 1305-1309
        • Spain D
        • Crilly J
        • Whyte I
        • Jenner L
        • Carr V
        • Baker A
        Safety and effectiveness of high-dose midazolam for severe behavioural disturbance in an emergency department with suspected psychostimulant-affected patients.
        Emerg Med Aust. 2008; 20: 112-120
        • Howes MC
        • van Rensburg WJ
        Thiopentone sedation for sedation of acutely agitated, violent, intoxicated patients: Evaluation of 2 cases.
        Int J Emerg Med. 2009; 2: 47-49
        • Melamed E
        • Oron Y
        • Ben-Avraham R
        • Blumenfeld A
        • Lin G
        The combative multi-trauma patient: a protocol for prehospital management.
        Euro J Emerg Med. 2007; 14: 265
        • Svenson JE
        • Abernathy MK
        Ketamine for prehospital use: new look at an old drug.
        Am J Emerg Med. 2007; 25: 977-980
        • Roberts JR
        • Geeting GK
        Intramuscular ketamine for the rapid tranquilization of the uncontrollable, violent, and dangerous adult patient.
        J Trauma. 2001; 51: 1008-1010
        • Fox FL
        • Bostwick JM
        Propofol sedation of refractory delirious mania.
        Psychosomatics. 1997; 38: 288-290
        • Cluver JS
        • Hardesty SJ
        Propofol for severe, refractory mania: a case report.
        J Clin Psychiatry. 2006; 67: 165-166
        • Vargo JJ
        Procedural sedation.
        Curr Opin Gastroenterol. 2010; 26: 421-424
        • Rex DK
        • Deenadayalu VP
        • Eid E
        • et al.
        Endoscopist-directed administration of propofol: a worldwide safety experience.
        Gastroenterology. 2009; 137: 1229-1237
        • Hohl MC
        • Sadatsafavi M
        • Nosyk B
        • Anis AH
        Safety and clinical effectiveness of midazolam versus propofol for procedural sedation in the emergency department: a systematic review.
        Acad Emerg Med. 2008; 15: 1-8
        • Marik PE
        Propofol: therapeutic indications and side-effects.
        Curr Pharmaceutical Design. 2004; 10: 3639-3649
        • Mancuso CE
        • Tanzi MG
        • Gabay M
        Paradoxical reactions to benzodiazepines: literature review and treatment options.
        Pharmacotherapy. 2004; 24: 1177-1185