CRD summary: This review assessed the effects of propofol for procedural sedation in the emergency department. The authors concluded that the evidence suggests that propofol is safe and effective, but the studies generally used deeper sedation than that recommended in the UK for non-anaesthetists. Poor reporting of the review methods and differences between the studies make it difficult to confirm the robustness of the conclusions.

CRD commentary: The review question was clear in terms of the intervention and participants, although the inclusion criteria were not explicitly defined. Inclusion criteria for study design and outcomes were not defined, and this resulted in the inclusion of observational studies and controlled trials that assessed a wide variety of outcomes. The methodological rigour of the study selection process was unclear as two potentially relevant studies were excluded from the review based on criteria not previously specified. Three relevant databases were searched and some limited attempts were made to locate unpublished studies. By limiting the included studies to those in English, the authors might have missed some relevant studies. The methods used to select studies, assess validity and extract the data were not described, so it is not known whether any efforts were made to reduce reviewer errors and bias. Some quality aspects were assessed but it was not clear if validity was assessed systematically. A narrative synthesis was appropriate given the diversity of the studies, but attention was not drawn to higher quality evidence and, overall, little attempt was made to structure the existing evidence. Comparisons across controlled studies were difficult because of the range of comparators and the use of propofol in combination with other agents in some studies. Overall, as the methods used to conduct the review were not reported, it is difficult to comment on the strength of the evidence underpinning the authors' conclusions.