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> how do you get past the "propofol" phobia and use this in the ED but not as procedural sedation?

--> If by this you mean how do we get by without permission from anaesthesia, then the answer is that we're in the UK and so none of us would ever dream of asking any other specialty for advice on how to do EM and, again in the UK, they don't tend to answer when not asked...

If you mean to find out how we'd get it used without it coming under our sedation guideline - the easiest way is writing a migraine guideline. That any drug may be used for one function does not preclude it's consideration for another, nor should it "label" that drug.

> Second, propofol can be very painful when administer peripherally?  Do you use some lido?

--> I have not come across this issue. Have had propofol myself before (at a really good party; only kidding - a couple of procedures in the past) and it was not an issue. If anyone DOES find it an issue, then I would be curious to find out more. 		 	   		  
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