| Valtonen M et al,
1988, Finland |
35 patients undergoing elective cardioversion due to atrial fibrillation. 30 patients received one cardioversion. 5 patients were cardioverted twice in the study period and received the other form of sedation the on the second occasion. Patients were randomised to receive either 2.5 mg/kg propofol or 5 mg/kg thiopentone and then observed until unresponsive to speech. The patient was then given up to 3 DC shocks |
RCT |
Induction time |
72.0 (20.0) s for propofol v 60.3 (13.0) s for thiopentone |
Small group. Much of the data provided in form of graphs so unable to extract it to put in table |
| Time to orientation—from end of procedure |
7.7 (2.9) min for propofol v 6.5 (4.4) min for thiopentone |
| Successful cardioversion |
11/15 for propofol, 13/15 for thiopentone |
| Ford S et al,
1991, USA |
16 male patients undergoing elective cardioversion for atrial fibrillation or flutter. Patients were randomised to receive 0.2% etomidate or 2.5% thiopental. The drugs were administered at 2 ml every 15 s until the patient no longer responded to verbal commands. Observer blinded to drug received |
RCT |
Change in mean heart rate |
Etomidate decreased the mean heart rate by 5%, thiopental increased it by 7% |
Small study |
| Change in mean arterial pressure |
Etomidate decreased MAP by 4%, thiopental decreased it by 3% |
| Failure of cardioversion |
1 in each group |
| Pt recall of cardioversion |
1 in each group |
| Time of onset of adequate sedation (min) |
Etomidate 1.8 (0.2); thiopental 2.3 (0.2) |
| Orientation time (min) |
Etomidate 7.4 (1.2); thiopental 10.1 (3.5) |
| Myoclonus |
Etomidated 3/8 pts; thiopental 0/8 pts |
| Canessa R et al,
1991, Chile |
44 patients with atrial flutter or fibrillation attending for elective cardioversion. All patients received 1.5 µg/kg fentanyl in addition to the sedative. Patients randomised by last digit of case‐note number to one of 4 agents for sedation. 12 pts received 3 mg/kg thiopental (T), 10 patients received 0.15 mg/kg etomidate (E), 12 patients received 1.5 mg/kg propofol (P) and 10 patients received 0.15 mg/kg midazolam (M) |
RCT |
Change in mean systolic blood pressure |
T decreased by 19%, E no significant difference, P decreased by 29%, M decreased by 19% |
Small groups. Poor method of randomisation (treating doctor knows which drug patient will receive before decides whether or not to recruit them). Not clear how randomised between four outcomes using ten digits |
| Successful cardioversion |
T 12/12; E 7/10; P ? 11/12 (given as 90%); M 9/10 |
| Mean induction time in seconds (range) |
T 31(10–50); E 34 (12–49); P 17 (1040); M 68 (30–220) |
| Myoclonus |
T 0; E 3; P 0; M 0 |
| Apnoea (loss of ventilatory effort >30 s) |
T 2/12; E 1/10; P 7/12; M 1/10 |
| Gale DM et al,
1993, USA |
Thirty adult patients with atrial fibrillation, atrial flutter, or paroxysmal supraventricular tachycardia requiring electrical cardioversion |
RCT |
Haemodynamics |
No significant difference |
Groups slightly dissimilar at baseline. Small study, power study not done |
| Dose requirements |
Propofol: 1.69 (0.46) mg/kg. Methohexital: 1.07 (0.34) mg/kg. Midazolam: 0.16 (0.06) mg/kg. |
| Patients were randomised to receive one of three study drugs: propofol, midazolam or methohexital |
Time to awakening |
Propofol: 11.2 (4.4) min. Methohexital: 9.4 (2.8) min. Midazolam: 33.1 (15.1) min |
| Adverse effects |
Propofol: 2/10 patients recalled shock 1 h after event. Pain on injection noted. Methohexital: One patient recalled shock. Midazolam: 5/10 patients with post‐recovery confusion lasting >10 min |
| Herregods L et al,
2003, Belgium |
34 patients with atrial arrhythmias who were scheduled to receive repetitive electrical cardioversion. 9 patients were not successfully cardioverted at the first or second session and so only 25 patients were analysed. Patients randomised in prospective double‐blinded study to receive either 0.2 mg/kg etomidate or 1 mg/kg propofol. The patients were then cardioverted again at least one week later using the alternative agent. Patients who were not successfully cardioverted by four attempts at either session were excluded |
RCT |
Required manually assisted ventilation |
7/25 etomidate v 5/25 propofol |
No information about induction times. Small group |
| Time to opening eyes (s) |
6.1 (2.0) etomidate v 4.7 (1.2) propofol |
| Myoclonus |
6/25 etomidate v 0/25 propofol |
| Signficant decrease in BP |
No patients in either group |
| Mitchell A et al,
2003, UK |
141 patients attending one unit for elective cardioversion of an atrial tachyarrhythmia who had not been cardioverted under sedation previously. Patients were randomised to receive diazepam (5–10 mg bolus followed additional 5–10 mg doses every minute up to a maximum of 70 mg) or midazolam (5 mg bolus plus 1–2 mg every minute up to a maximum of 30 mg) |
RCT |
Successful cardioversion |
87% of pts receiving diazepam v 89% of patients receiving midazolam |
Only patients blinded to drug received |
| Episode of hypotension (decrease in systolic BP >20 mmHg or systolic BP <100 mmHg. |
7% of pts receiving diazepam v 20% of patients receiving midazolam |
| Episode of oxygen desaturation (<99% despite supplementary oxygen) |
No patients receiving diazepam v 3% of patients receiving midazolam |
| Time for adequate sedation (min) |
Diazepam 6.5 (3.4) v midazolam 5.0 (3.4) |
| Time till awake and orientated (min) |
Diazepam 39 (24) v midazolam 77 (46) |
| Pt able to recall events |
1 in diazepam group, none in midazolam group |
| Coll‐Vincent B et al,
2003, USA |
Thirty two hemodynamically stable adult patients undergoing cardioversion in the ED |
RCT |
Induction time |
Propofol: 50 (30–100) s Etomidate: 90 (25–120) s. Midazolam: 120 (30–180) sec. Midazolam + Flumazenil: 112 (30–350) s |
|
| Haemodynamics |
No significant differences |
| These patients were randomised receive etomidate, propofol, midazolam, or midazolam followed by flumazenil |
Time to awakening |
Propofol: 8 (3–15) min. Etomidate: 9.5 (5–11). Midazolam: 21 (1–42). Midazolam + Flumazenil: 3 (2–5) |
| Adverse effects |
Propofol: 1/9 broncho‐spasm. Etomidate: 4/9 myoclonus, 1 bronchospasm, 4 pain at injection site, 2 cough Midazolam: 3 dizziness Midazolam + Flumazenil: 5 resedation |
