Recommended Citation
Hajiharis M, Shah A, McInerney A. The Rhythm of Sedation: Comparison of Methohexital, Propofol, and Etomidate for ED Cardioversions. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Background/Significance:
Cardioversions in the emergency department (ED) allow for a controlled shock to be delivered to the heart to restore normal sinus rhythm in dysrhythmic states such as atrial fibrillation and supraventricular tachycardia. Sedation used during this procedure helps to reduce anxiety, pain, and discomfort. There are several general anesthetics available, and those with a quick onset and recovery time with minimal side effects are favorable. Current data is limited, with one retrospective review by Bauer and colleagues comparing methohexital to propofol and etomidate for procedural sedation in ED cardioversions finding no statistically significant difference in the time from first dose of the agent to clinical recovery.
Purpose:
The purpose of this study was to compare the pharmacodynamic profiles of etomidate, methohexital, and propofol in emergency cardioversions.
Methods:
This retrospective review looked at adult patients that had undergone electrical cardioversion with either methohexital, etomidate, or propofol in the ED. There were 255 patients screened between November 2019 and September 2025 with 194 meeting the inclusion criteria.105 received etomidate, 47 received methohexital, and 42 received propofol. Patients were excluded if they received an alternative agent prior to the study of drug, had incomplete documentation, or underwent a noncardiac procedure. Descriptive statistics were performed for all continuous and categorical data using Wilcoxon Rank Sum and Fisher’s exact tests.
Results:
There was no difference seen in our primary outcome of time (min) from sedative administration to procedure end time between etomidate, methohexital, and propofol (9 versus 7 versus 9.4, p=0.20). The etomidate group required less additional doses (p=0.06) and received more concomitant analgesia with fentanyl (p≤0.01). Dosing was found to be on the lower end of the dosing range for methohexital (0.51 mg/kg) and propofol (0.53 mg/kg). Differences in systolic blood pressure were statistically significant but as expected for propofol and methohexital (p≤0.01).
Conclusion:
Despite etomidate requiring fewer additional doses, all three agents appear to be similar in terms of efficacy and safety. Although medication selection did not make a difference with procedure times, we did not evaluate patient comfort with pain and sedation endpoints. Looking forward, it could be beneficial to do a prospective study, compare sedatives for other procedures, and evaluate the use of concomitant analgesics for procedures.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
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Document Type
Poster
Open Access
Available to all.
The Rhythm of Sedation: Comparison of Methohexital, Propofol, and Etomidate for ED Cardioversions
Background/Significance:
Cardioversions in the emergency department (ED) allow for a controlled shock to be delivered to the heart to restore normal sinus rhythm in dysrhythmic states such as atrial fibrillation and supraventricular tachycardia. Sedation used during this procedure helps to reduce anxiety, pain, and discomfort. There are several general anesthetics available, and those with a quick onset and recovery time with minimal side effects are favorable. Current data is limited, with one retrospective review by Bauer and colleagues comparing methohexital to propofol and etomidate for procedural sedation in ED cardioversions finding no statistically significant difference in the time from first dose of the agent to clinical recovery.
Purpose:
The purpose of this study was to compare the pharmacodynamic profiles of etomidate, methohexital, and propofol in emergency cardioversions.
Methods:
This retrospective review looked at adult patients that had undergone electrical cardioversion with either methohexital, etomidate, or propofol in the ED. There were 255 patients screened between November 2019 and September 2025 with 194 meeting the inclusion criteria.105 received etomidate, 47 received methohexital, and 42 received propofol. Patients were excluded if they received an alternative agent prior to the study of drug, had incomplete documentation, or underwent a noncardiac procedure. Descriptive statistics were performed for all continuous and categorical data using Wilcoxon Rank Sum and Fisher’s exact tests.
Results:
There was no difference seen in our primary outcome of time (min) from sedative administration to procedure end time between etomidate, methohexital, and propofol (9 versus 7 versus 9.4, p=0.20). The etomidate group required less additional doses (p=0.06) and received more concomitant analgesia with fentanyl (p≤0.01). Dosing was found to be on the lower end of the dosing range for methohexital (0.51 mg/kg) and propofol (0.53 mg/kg). Differences in systolic blood pressure were statistically significant but as expected for propofol and methohexital (p≤0.01).
Conclusion:
Despite etomidate requiring fewer additional doses, all three agents appear to be similar in terms of efficacy and safety. Although medication selection did not make a difference with procedure times, we did not evaluate patient comfort with pain and sedation endpoints. Looking forward, it could be beneficial to do a prospective study, compare sedatives for other procedures, and evaluate the use of concomitant analgesics for procedures.
Affiliations
Advocate Lutheran General Hospital