We compare the efficacy, adverse events, and recovery duration of etomidate and propofol for use in procedural sedation in the emergency department (ED). A randomized nonblinded prospective trial of adult patients undergoing procedural sedation for painful procedures in the ED was made. Patients received either propofol or etomidate. Doses, vital signs, nasal end-tidal CO2 (etco2), pulse oximetry, and bispectral electroencephalogram analysis scores were recorded. Subclinical respiratory depression was defined as a change in etco2 greater than 10 mmHg, an oxygen saturation of less than 92% at any time, or an absent etco2 waveform at any time. Clinical events related to respiratory depression, including an increase in supplemental oxygen, the use of a bag-valve-mask apparatus, airway repositioning, or stimulation to induce breathing, were noted. Etomidate and propofol appear equally safe for ED procedural sedation. Etomidate had a lower rate of procedural success and induced myoclonus in 20% of patients (see Table 1).