<NB. I usually use Propofol plus an opiate or ketoralac, sedation is very
easy to control and they come round asap).
I agree, Simon, manipulation of dislocated shoulder can be done, in 90-95% of cases, using opiates and nitrous oxide; the rest of the cases I "reduce" them using propofol.
One of the main reasons for the "bad name" of sedation performed by non-anaesthetists is the use of drugs, such as midazolam, by orthopaedic SHOs. They perpetuate this amazing idea that a sedated patient should be as close as a death patient as possible. The patient should not move, make any noise, or even,in some cases, breathe.
In these cases, flumazenil could be dangerous because provide a false sense of security, the dose given is probably too large to be fully and safely reversed, without careful observation.
Andres I. Martin
SpR in Emergency Medicine
Royal Free Hospital
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