Dexmedetomidine intravenous sedation using a patient-controlled sedation infusion pump: a case report

Dental treatment under sedation requires various sedation depths depending on the invasiveness of the procedure and patient drug sensitivity. Inappropriate sedation depth may cause patient discomfort or endangerment. For these reasons, patient-controlled sedation (PCS) pumps are commonly used. Patients are able to control the sedation depths themselves by pushing the demand button after the practitioner sets up the bolus dose and lock-out time. Dexmedetomidine is an α-2 adrenoreceptor agonist with sedative, analgesic, and anxiolytic properties. It has been widely used for sedation for its minimal respiratory depression; however, there are few studies on PCS using dexmedetomidine. This study assessed the applicability of dexmedetomidine to PCS.

Correlation study of Narcotrend values and patient-controlled sedation of dexmedetomidine under CSEA / 实用医学杂志

Objective To explore the correlation of patient-controlled sedation of dexmedetomidine and Narcotrend values. Methods Forty patients with lower limb surgery were enrolled. Until CSEA block fixed , the electronic pump ran the patient-controlled sedation of dexmedetomidine. The parameter of electronic pump was set as follows: load dose 2 mL + background dose 1.5 mL/h + single dose 0.5 mL + locktime 20 s. The heart rate , mean arterial pressure, pressing times, effective times, OAA/S sedation scores and NI values were determined. Results At T4 point, the patients reached appropriate sedation. At T4 ~ T9 OAA/S scores kept 3 to 4. From T5 point, NI values showed significant decrease. After the T7 point. OAA/S scores and NI values reached the plateau time of (7.5 ± 1.8) min and (13.1 ± 3.4) min, OAA/S scores of 1, 2, 3, 4, respectively, corresponding roughly with NI values 95 to 100, 90 to 94, 65 to 89, 40 to 64. The correlation coefficient was 0.58. The time of NI values significant decreased in the younger group and in the elderly group, with (10.2 ± 1.6) min and (14.4 ± 2.2) min. In T5~ T9 point, NI values of the younger group were significantly lower than those in the elderly group. Conclusion Relevant relationships are observed between dexmedetomidine patient-controlled sedation depth and the narcotrend values under CSEA.

The comparison of sedation quality, side effect and recovery profiles on different dosage of remifentanil patient-controlled sedation during breast biopsy surgery / 대한마취과학회지

BACKGROUND: The patient-controlled sedation (PCS) allows for rapid individualized titration of sedative drugs. Propofol has been the most widely used IV adjuvant, during the monitored anesthesia care (MAC). This study was designed to compare the sedation quality, side effect and recovery of the propofol alone, and propofol-remifentanil combination, using PCS for breast biopsy. METHODS: Seventy five outpatients, undergoing breast biopsy procedures with local anesthesia, were randomly assigned to receive propofol alone (group P), propofol-25 ug/ml of remifentanil (group PR25), and propofol-50 ug/ml of remifentanil (group PR50), using PCS. Pain visual analogue scores (VAS) and digit symbol substitution test (DSST), Vital signs, bi-spectral index (BIS) and observer assessment of alertness and sedation (OAA/S) score were recorded. RESULTS: Apply/Demand ratio in the group PR50 had a significant increase over the other groups (P < 0.05). The incidence of excessive sedation and dizziness were significantly more frequent in the group PR50 (P < 0.05). BIS and OAA/S score significantly decreased in the group PR25, PR50 at 15 min after the operation, the end of surgery (P < 0.05). At 5 min after the start of PCS, patients in the group PR25 and PR50 gave significantly less correct responses on the DSST than that of the group P (P < 0.05). CONCLUSIONS: Compared with the propofol alone, intermittent bolus injection of propofol-remifentanil mixture could be used, appropriately, for the sedation and analgesia during MAC. The group PR25 in a low dose of remifentanil has more advantages in terms of sedation and satisfaction because of the group PR50's side effects.

Comparison of alfentanil and remifentanil for the use of patient controlled sedation under local anesthesia during ear, nose and throat surgery / 대한마취과학회지

BACKGROUND: This study was conducted to compare the effects of alfentanil and remifentanil on patient controlled sedation (PCS). METHODS: 60 patients scheduled for ear, nose and throat surgery under local anesthesia were randomly allocated to Group P (n = 20, propofol 10 mg/ml), Group A (n = 20, propofol 10 mg/ml with alfentanil 500 microg/ml) and Group R (n = 20, propofol 10 mg/ml with remifentanil 10 microg/ml). Without a basal rate, bolus was set to 2 ml with one minute of lockout time. RESULTS: A total of 57 patients were included in this study. Group A was found to have a lower blood pressure and pulse rate than group R. Group R showed a lower PCS dose upto an OAA/S (Observer's Assessment of Alertness/Sedation Scale) value of 4 and a higher OAA/S prior to surgery than group P. Group P was found to have a higher blood pressure and respiration rate than Group A. During PCS, patient anxiety was significantly decreased in all groups. In addition, there was no differences among groups in the level of pain during the perioperative period, delivery/attempt ratio, satisfaction of the patient and surgeon, and number of patients required to undergo the same PCS technique again. The frequency of side effects of PCS, which included pain on injection, transient hypertension, hypotension, desaturation and oversedation, were similar among groups. CONCLUSIONS: Evaluation of patients who underwent ear, nose and throat surgery under local anesthesia using PCS with propofol alone or alfentanil or remifentanil revealed no differences in safety, effectiveness, complications or satisfaction of the patients and surgeons.

The effect of midazolam premedication on patient satisfaction during fiberoptic bronchoscopy under patient-controlled sedation / 대한마취과학회지

BACKGROUND: Patient-controlled sedation (PCS) with propofol is a safe and effective method of attenuating discomfort during fiberoptic bronchoscopy. The purpose was to evaluate the usefulness of midazolam in addition to PCS for fiberoptic bronchoscopy. METHODS: We randomly assigned 155 patients undergoing diagnostic bronchoscopy to two groups. Group M (n = 79) received 0.03 mg/kg of midazolam for premedication while group P (n = 76) received a loading dose (0.05 ml/kg) of PCS solution composed of 200 mg (20 ml) of propofol and 1 mg (2 ml) of alfentanil. Both groups received the PCS solution 0.2 ml/kg/hr with a bolus of 1 ml and a lockout time of 1 min. Vital signs, pulmonologist satisfaction, patient satisfaction and amnesia were evaluated. RESULTS: After the insertion of the bronchoscope, there was a slight decrease of SpO2 and an increase of blood pressure and heart rate in both groups with no significant differences between the two groups. The group P required more bolus injections (1.6 +/- 1.7 in the group M vs 2.5 +/- 2.2 in group P; P < 0.05). There was no difference in the satisfaction of pulmonologists, but the satisfaction of patients was higher in the group M (P < 0.05). More patients in the group P (93%) remembered the procedure than in the group M (70%) (P < 0.05). CONCLUSIONS: PCS is an effective method for sedating patients undergoing fiberoptic bronchoscopy and midazolam provides more patient satisfaction and amnesia.

The Comparison of Sedation Quality, Side Effects, and Recovery Profiles of Propofol Alone, Propofol-Fentanyl and Porpofol-Ketamine PCS for MAC / 대한마취과학회지

BACKGROUND: Propofol has been the most widely used IV adjuvant during Monitored anesthesia care (MAC), even though it lacksanalgesic properties. This study was designed to compare sedation quality, side effects, and recovery profiles of propofol alone (group P), propofol-fentanyl (group PF) and propofol-ketamine (group PK) using PCS for breast biopsy procedures using local anesthesia. METHODS: Anxiety VAS, pain VAS and digit symbol substitution test (DSST) were measured in 60 excision breast biopsy patients with local anesthesia. Vital signs, respiratory (SpO2, RR, and ETCO2) variables, BIS, and OAA/S scores were recorded. Perioperative side effects (e. g., pain on injection, excessive sedation [OAA/S < 4], hypoventilation [ventilatory frequency 8 bpm], hypotension, dizziness, unpleasant feeling, Nausea) were also noted. RESULTS: There were no differences among the three PCS groups with respect to demographic data (Table 1). A/D ratio in PK group had a significant increase over P group. The incidence of excessive sedation and dizziness were significantly more frequent in the PK group patients (P < 0.05)(Table 1, 2). OAA/S scores were significantly decreased in the PK group during near the end of surgery, whereas BIS scores were only at the end of surgery (P < 0.05)(Fig. 1, 2). During 15 min after arrival at recovery room, significantly less patients in the PK group gave correct responses on the DSST than other groups (P < 0.05)(Fig. 2, 3). CONCLUSIONS: In contrast to past studies of ketamine as an alternative to opioid adjuncts during propofol PCS, it has no more advantage than supplemental fentanyl in terms of sedation level and side effects.

Topical Anesthesia Combined with Patient-Controlled Sedation Analgesia (PCSA) for Posterior Vitrectomy

PURPOSE: To investigate the effects of topical anesthesia combined with patient-controlled sedation analgesia for posterior vitrectomy. METHODS: All patients requiring vitrectomy from December 2003 to January 2004 at Seoul National University Hospital underwent surgery with topical anesthesia combined with patient-controlled sedation analgesia. The levels of intraoperative pain and sedation were recorded. The associations of operation time, combined vitreoretinal procedures, and age with intraoperative pain were investigated. Hemodynamic instability and respiratory depression were checked throughout the operation. RESULTS: Forty-three patients (53 eyes) underwent vitrectomy under topical anesthesia combined with patient-controlled sedation analgesia. The mean age was 51.75 +/- 13.68 years and the sex ratio was 25: 28 (male: female). The mean of VAS (visual analogue scale) was 53.61 (5 ~ 67). The level of intraoperative sedation was grade 1 (64%) or 2 (36%). No anesthesia-associated complications were found. CONCLUSIONS: In spite of relatively high VAS, there were no remarkable difficulties in performing posterior vitrectomy and appropriate levels of intraoperative sedation and cooperation were available without anesthesia-associated complications.

Patient-Controlled Sedation versus Nurse-Administered Sedation with Propofol during Colonoscopy / 대한소화기내시경학회지

BACKGROUND/AIMS: Patient-controlled sedation (PCS) allows the patients to titrate the dosages of sedative drug according to their needs. The objective of this study was to compare the safety and the efficacy of nurse-administered propofol sedation (NAPS) with those of PCS. METHODS: Eighty one patients were randomly assigned to two groups. All patients received meperidine 25 mg and propofol 40 mg as an initial dose for sedation. Patients in PCS group were subsequently infused with propofol 15 mg over 80 seconds through infusion pump whenever they required. Patients in NAPS group were injected with 10~20 mg propofol by nurse with supervision by endoscopist. The dosage of propofol, cardiopulmonary parameters, procedure time, sedation score, pain score, the patients' and endoscopists' satisfaction scores were assessed. RESULTS: With regard to blood pressure, pulse rate and oxygen saturation, serious complications were not observed. Especially, there was no significant difference of mean total dose between two groups (NAPS group and PCS group received 76.7+/-24.7 mg and 82.5+/-26.6 mg respectively). Pain score was higher in woman than in man (p=0.03). CONCLUSIONS: 1.2~1.5 mg/kg of propofol with small dose of opioid during colonoscopy was effective and safe. NAPS was more practical and useful method of sedation than PCS during colonoscopy.

Patient-controlled Sedation with Propofol and Alfentanil during Colonofiberscopy / 대한마취과학회지

BACKGROUND: The aim of this study was to examine the safety and efficacy of patient-controlled sedation (PCS) according to the lock-out time (LOT, 1 or 2 min) with a demand bolus of propofol and alfentanil fixed during a colonofiberscopy. METHODS: Fifty ASA physical status 1 or 2 patients who underwent a colonofiberscopy were enrolled in this study. They were provided with a PCS pump (Perfusor(R) fm, B Braun Germany, nominal infusion rate, NIR = 1,000 ml/h) containing propofol (9.1 mg/ml) and alfentanil (45.5microgram/ml) in order to self-administer a 2 ml bolus whenever they felt uncomfortable. The lock-out time (LOT) was set to 1 (n = 20, group 1) or 2 (n = 30, group 2) minutes. The Observer's Alertness/Sedation (OAA/S) score, D/A (delivery/attempt, %), blood pressure, heart rate, respiratory rate, SpO2, end tidal CO2 and bispectral index (BIS) were assessed and measured during and/or after the procedures. The verbal descriptive pain scores, as well as the patient's and endoscopist's satisfaction scale were assessed after the procedures. RESULTS: Intraoperative and postoperative pain scores, D/A, the patient's and endoscopist's satisfaction were similar in both groups. However, the lowest BIS values in group 1 was lower than in group 2 (70.3 +/- 12.2 and 77.6 +/- 6.8, respectively, P = 0.010). There were fewer patients whose lowest OAA/S score was <3 in group 2 (4/30) than in group 1 (11/20)(P = 0.002). CONCLUSIONS: With a demand bolus of propofol (18.2 mg) and alfentanil (91.0microgram) fixed, the incidence of over-sedation was higher at LOT 1 min than at LOT 2 min while the efficacy was similar in the PCS with a high NIR during the colonofiberscopy.

Evaluation of Auditory Evoked Potential and Bispectral Index in Patient-Controlled Sedation with Propofol / 대한마취과학회지

BACKGROUND: The auditory evoked potential (AEP) index and bispectral (BIS) index have been proposed as methods to measure the depth of sedation. A prospective study was designed to assess the performance of both these methods for measuring the depth of sedation induced by propofol patient-controlled sedation (PCS) under spinal anesthesia. METHODS: Forty ASA I and II adult patients under spinal anesthesia using 0.5% hyperbaric bupivacaine were studied. Group 1 (10 mg bolus, 30 mg loading) and Group 2 (20 mg bolus, 60 mg loading) received propofol and maintained PCS with 1min lockout interval and 100 mg/hr continuous infusion. AEP, BIS and Observer's assessment of alertness/sedation (OAA/S) scale were monitored during the operation. RESULTS: AEP and BIS decreased and increased following the changes on the patient's OAA/S scores and correlated with sedation significantly. There were no significant difference in mean AEP index (group 1; 13.4 +/- 8.4, group 2; 8.9 +/- 6.2), BIS index (group 1; 76.2 +/- 9.7, group 2; 71.2 +/- 9.8), and OAA/S scale (group 1; 3.8 +/- 1.3, group 2; 3.2 +/- 1.5) between the groups. Incidence of perioperative respiratory depression was significantly higher in group 2 (25%) than group 1 (5%), and incidence of involuntary movement was significantly higher in group 1 (20%) than group 2 (5%) (P < 0.05). CONCLUSIONS: Both AEP and BIS correlated well with the depth of sedation induced by propofol PCS under spinal anesthesia. AEP seems to be more valuable in measuring the change between consciousness and unconsciousness, and BIS seems to be more effective in measuring the depth of sedation.

Patient-Controlled Sedation for Local Anesthesia Patients in Plastic Surgery / 대한마취과학회지

BACKGROUND: Patient-controlled sedation (PCS) involves the patient self administering the sedative agent to the point at which the patient is satisfied with the level of sedation with the advantage to overcome the phamacodynamic differences between individual patients. We performed the PCS with two different dosages of propofol and compared the efficacy and side effects for local anesthesia patients in plastic surgery. METHODS: Thirty patients underwent propofol PCS with Perfusor fm (B. Braun, Germany) PCA pump during nasal inhalation of O2 3 L/min with continuous monitoring of SpO2. PCS settings were 10 mg of bolus dose, 30 mg of initial loading dose, 1 min of lockout interval, 100 mg/hr of continuous infusion in group 1 and 20 mg of bolus dose, 60 mg of initial loading dose, 1 min of lockout interval, 100 mg/hr of continuous infusion in group 2. All the patients received local anesthesia with 1% lidocaine before operation. Observer's assessment of alertness/sedation (OAA/S) scale, SpO2, mean infusion rate of propofol, duration of induction and recovery, recall of operative procedure, and patient's and surgeon's satisfaction were checked. RESULTS: The mean infusion rate (group 1; 32.2 +/- 19.4, group 2; 38.3 +/- 20.5 ug/kg/min), duration of induction (group 1; 4.9 +/- 1.9, group 2; 3.1 +/- 1.4 min), duration of recovery (group 1; 1.7 +/- 1.2, group 2; 2.5 +/- 1.3 min), and mean OAA/S scale (group 1; 3.8 +/- 1.6, group 2; 3.1 +/- 1.5) were not significantly different between the groups (mean +/- SD). Inadequate sedation occurred more frequently in group 1 (13%) than group 2 (0%), and incidences of respiratory depression (SpO2 < 95%) were more higher in group 2 (20%) than group 1 (0%). Numbers of satisfaction of patient and surgeon were 100% and 87% in group 1, and 87% and 93% in group 2. CONCLUSIONS: 10 mg or 20 mg as a bolus dose and 30 mg or 60 mg as a initial loading dose of propofol for PCS provided effective sedation and patient's and surgeon's satisfaction without significant side effect for local anesthesia patients in plastic surgery. (Korean J Anesthesiol 2004; 46: 583~588)

The Negative Effects of Patient Controlled Sedation Using Midazolam for Cataract Surgery under Retrobulbar Block / 대한마취과학회지

BACKGROUND: Careful sedation is needed for cataract operation that requires absolute cooperation of elderly patients. Patient-controlled sedation (PCS) allows patients themselves change the dose of sedatives along with their need. The goal of this study was to find out midazolam PCS could achieve an adequate sedation without complications during cataract surgery and the differences of patients who needed PCS or not. METHODS: PCS with midazolam was applied to 33 patients undergoing cataract surgery using retrobulbar block (midazolam, bolus 0.5 mg, lock out interval 3 minutes, 1 hour limit 4.5 mg). PCS pump was given to patients 30 min before retrobular block. And patients themselves decided to use or not to use PCS after full explanation on PCS. Sedation score, visual analogue scale of anxiety, cognitive function, side effects and satisfaction of PCS were measured. RESULTS: PCS users were 22 (67%). Mean midazolam dosage of PCS users was 2.03 mg. Preoperative and intraoperative anxiety score were 40.2 mm and 13.0 mm in PCS users and 15.5 mm and 21.8 mm in non-users. The difference between PCS users and non-users was only preoperative anxiety levels. Age, sex, weight, education levels, previous cataract surgery, preoperative desired sedation levels did not influence on the PCS using. There was positive correlation of midazolam doses with only preoperative anxiety levels. 76% of surgeons and 85% of patients were satisfied with PCS but 7 patients showed involuntary movement. Cognitive functions and discharge time were not influenced by PCS. CONCLUSIONS: Although patients and surgeons were satisfied with the midazolam PCS, 33% of patients did not need PCS and deep sedation with involuntary movement that could bring surgical complications was resulted in some PCS users. We conclude that PCS for cataract surgery would be safer when it is administered under careful supervision of anesthesiologist.

Conscious Sedation Using a Patient-Controlled Sedation Technique / 대한마취과학회지

BACKGROUND: Patient-controlled sedation (PCS) involves the patient self administering the sedative agent to the point at which he or she is satisfied with the level of sedation with the advantage to overcome the pharmacodynamic differences between individual patients. We compared three different bolus dosages of propofol for providing effective and safe sedation during PCS. METHODS: Sixty patients underwent spinal anesthesia with 0.5% hyperbaric bupivacaine 12-18 mg or a brachial plexus block with 1% mepivacaine 40 ml. These patients were allowed to self-administer a propofol bolus dose of either 4 mg (P4 group), 10 mg (P10 group), or 20 mg (P20 group) at a time to the point of the patient's satisfaction with the level of sedation. Infusion rate, BIS (bispectral index), SpO2, duration of induction and recovery, recall of operative procedure and patient's satisfaction were checked. RESULTS: The mean (range) infusion rate (ug/kg/min) was not significantly different among the groups: P4 group, 24.2 (14.3 - 69.7); P10 group, 26.4 (19.4 - 72.1); and P20 group, 30.4 (21.4 - 89.1). Duration of induction was significantly extended in the P4 (14.1 min) and P10 group (12.9 min) as compared with the P20 group (6.0 min). The mean value of the OAA/S (observer's assessment of alertness/sedation) scale and BIS and the numbers of recall were significantly lower in the P20 group than the other groups (p < 0.05). Inadequate sedation and involuntary movement occurred more frequently in the P4 and P10 group than the P20 group, and the numbers of satisfaction were higher in the P20 group than the other groups. CONCLUSIONS: 20 mg of propofol as a PCS bolus dose provided more effective sedation than 4 mg or 10 mg. When we use 4 mg or 10 mg of propofol as a bolus dose, we may want to consider combining if with other sedatives or analgesics (midazolam, ketamine, fentanyl).

The Efficacy of Patient-Controlled Sedation and Analgesia in Patients Undergoing Endoscopic Sinus Surgery / 대한마취과학회지

BACKGROUND: Patients receiving surgery under local anesthesia might feel anxiety during surgery and suffer pain due to the insufficiency of local anesthesia. The purpose of this study was to evaluate the efficacy and side effects of patient-controlled sedation and analgesia in patients undergoing endoscopic sinus surgery (ESS). METHODS: We studied 63 adult patients. A mixture of 400 mg of propofol and 200microgram of fentanyl (total 44 ml) was infused to the patient at a rate of 10 ml/hr using a PCA device. The lock-out time was 1 minute and the bolus dose was 1 ml. During surgery, we monitored vital signs and sedation state. At the end of surgery, we assessed the degree of satisfaction about pain and anxiety relieving effects by using a questionnaire with a 1 to 10 scale. RESULTS: About 90% of patients were wide awake during surgery, others were drowsy or intermittently sleeping. About 95% of the patients were satisfied with anxiety relief (more than a score of 8) and 84% were satisfied with pain relief in painful episodes (more than a score of 8). Vital signs were within normal limits. The oxygen saturation was maintained above 94% during surgery, except three patients whose oxygen saturation was 92% for short while. Twenty-two percent of the patients complained of pain at their drug infusion sites. CONCLUSIONS: We concluded that patient-controlled sedation and analgesia using the mixture of fentanyl and propofol might be a good way to relieve patient's anxiety and pain without respiratory depression and excessive sedation for those undergoing ESS under local anesthesia.

Patient Controlled Sedation Using Propofol during Regional Anesthesia for Cesarean Section / 대한마취과학회지

BACKGROUND: During regional anesthesia for a cesarean section, adverse effects such as nausea and/or vomiting (N&V), visceral pain and shivering are common complications. A subhypnotic dose of propofol has been known to have an antiemetic effect perioperatively. Patient controlled sedation (PCS) using propofol might be a solution for emesis and other adverse effects occurring during regional anesthesia in cesarean deliveries. METHODS: One hundred ten parturients scheduled for elective cesarean section were randomly divided into two groups: PCS-spinal (n = 55) and PCS-epidural (n = 55). Spinal anesthesia was performed with 0.5% bupivacaine 10 mg and 10 microgram of fentanyl. Epidural anesthesia was performed with 2% lidocaine 25 ml + 100 microgram of fentanyl + 0.1 mg of epinephrine + 1.5 ml of 8.4% sodium bicarbonate in the PCS-epidural group. After delivery, PCS with propofol was applied to the patients in both groups (bolus dose: 30 mg, lock-out time: 3 min, no background infusion). We investigated incidences of adverse effects such as N&V, hypotension, intraoperative visceral pain, and shivering during the operation. We also assessed sedation scores (Grade 1 - 5) in the patients of both groups. RESULTS: There was no difference in sensory levels between the groups. Although more patients in the PCS-epidural group complained of N&V (3.6%:20%, P = 0.018) and shivering (0%:14.5%, P = 0.036) in the PACU, there were no differences intraoperative adverse effects between both groups. The sedation score did not differ between the groups. CONCLUSIONS: With PCS using propofol, adverse effects during cesarean section under both regional anesthesias are negligible.

Comparison of Anesthesiologist-Controlled Sedation and Patient-Controlled Sedation with Propofol in Regional Anesthesia Patients / 대한마취과학회지

BACKGROUND: Propofol is a drug which has both sedative and anxiolytic properties which when given in IV form can provide a rapid onset of effects. However inter-individual dose requirement can vary widely, making titiration to effect essential. Patient-controlled sedation (PCA), which administers bolus doses of the sedative agent to the point at which the patient is satisfied have been found to be both effective and popular for patients undergoing surgery under loco-regional anethesia. The aim of this study was to compare the effectiveness and quality of target-controlled infusion (TCI) of propofol by the anesthesiologist (anesthesiologist-controlled sedation: ACS) versus PCS to achieve conscious sedation. METHODS: Sixty patients scheduled to undergo spinal anesthesia with 0.5% hyperbaric bupivacaine 12-18 mg or brachial plexus block with 1% lidocaine 40 ml were divided into 2 groups. In the ACS group (n = 30), the initial target concentration of propofol was 1.0 microgram/ml and the target concentration was adjusted in steps of 0.2 microgram/ml to maintain an Observer's Assesment of Alertness/Sedation (OAA/S) score of 3 with a TCI pump. In the PCS group (n = 30), a 20 mg bolus of propofol was delivered at each button without a lockout interval to the point at which a patient was satisfied with the level of sedation. Infusion rate, total dosage, duration of induction and recovery and recall of operative procedure were checked. BIS, EKG, heart rate, noninvasive anterial blood pressure, respiratory rate and SpO2 were recorded during the operation. RESULTS: The mean (range) infusion rate and total infusion dose were not significantly different with each group: ACS 38.5 (13.1-101.0) microgram/ml, 132 (80-241) mg/h and PCS 25.4 (21.3-80.1) microgram/ml, 118 (69-220) mg/h. Duration of induction was significantly extended in the PCS group (5.8 min) as compared with the ACS group (2.9 min)(P < 0.05). The intensity of amnesia related to blood propofol concentration was more improved in the ACS group and inadequate sedation and involuntary movement were occurred more frequently in the PCS group. CONCLUSIONS: PCS with propofol provided more effective sedation, but had more frequent delayedinduction time, inadequate sedation and incomplete amnesia than ACS.

Comparison of Propofol and Midazolam for Patient Controlled Sedation during Local Anesthesia / 대한마취과학회지

BACKGROUND: Surgical procedures carried out under local anesthesia are associated with patient discomfort and apprehension. The purpose of this study is to compare propofol and midazolam with regard to their suitability for the patient controlled sedation (PCS) technique during local anesthesia. METHODS: Forty unpremedicated, ASA physical status I day surgery patients undergoing elective minor surgery were randomly divided into two equal groups of patients who self-administered either propofol or midazolam intraoperatively. All patients initially received 0.5 g.kg-1 fentanyl. The bolus dose was either 20 mg (2 ml over 25 sec) of self-administered propofol or 0.5 mg (2 ml over 25 sec) of midazolam and lock-out period was 1 min. RESULTS: The onset of sedation following propofol was significantly faster than midazolam (p<0.05) and demands of propofol was significantly less than midazolam (p<0.05). There were no significant differences for postoperative recovery, sedation and comfort scale. CONCLUSIONS: Propofol was judged the more suitable agent for PCS than midazolam, because of its more rapid onset of sedation and less demands of drug.

Comparison of propofol sedation controlled by patient and with target-controlled infusion during epidural anesthesia / 中华麻醉学杂志

Objective To compare the effectiveness of patient-controlled propofol sedation (PCS) against propofol sedation with TCI during epidural anesthesia. Methods Thirty-two ASA Ⅰ -Ⅱ patients (18 male , 14 female) aged between 23-71 years, undergoing lower abdominal surgery or surgery on lower limb were randomly divided into two groups: PCS group ( n =16) and TCI group ( n = 16). Propofol sedation was started when epidural anesthesia was shown to be satisfactory. In PCS group a loading dose of propofol 0.5?g?kg-1 was given. The bolus dose was 0.3mg?kg-1 and the lock-out interval 2 min. There was no background infusion of propofol. In TCI group the initial target concentration of propofol was set at 1. 5?g?kg-1 target concentration was adjusted according to OAA/S score which was maintained at 3 during operation. Radial artery was cannulated and arterial blood samples were taken for determination of blood propofol concentration before and 5, 15, 30, 45 min after incision. OAA/S score was evaluated every 5 min and at the same time BIS and 95% SEF were recorded. The total amount of propofol infused during operation was recorded and whether the patient was satisfied with sedation was inquired. Results All patients expressed great satisfaction with the sedation in both groups. In PCS group the level of sedation was lighter and less propofol was consumed than in the TCI group. (2.5mg?kg-1 ?h-1 vs 3.8mg?kg?h-1, P

Patient-controlled sedation during epidural anesthesia / 中华麻醉学杂志

Objective: To evaluate the feasibility and advantages or disadvantages of patient-controlled sedation (PCS) compared with doctor-controlled sedation (DCS) during epidural anesthesia. Method: Forty patients were divided at random into two groups with 20 patients in each group. Patients in group I were administered by themselves a mixture of propofol (20mg) and fentanyl (10?g) in increments using a Graseby PCA infuser (lockout period 1 min) to achieve sedation; patients in group Ⅱ received propofol 3.6mg?kg~(-1)?h~(-1) and fentanyl 1.8?g~(-1)?kg~(-1)?h~(-1)contin uously intravenously by the anesthesiologist to achieve intra-operative sedation. Sedation scale, satisfaction and cooperation degrees were measured. Cognition was also evaluated using abbreviated Mini Mental Status Examination. Result: The drug total dose used in DCS group was higher than that in group PCS (P