Propofol-fentanil en bolo frente a ketofol en infusión continua para sedoanalgesia en colonoscopia electiva / Propofol-fentanyl bolus versus ketofol continuous infusion for sedation-analgesia in elective colonoscopy

Introducción: La colonoscopia se practica con frecuencia y la sedación consciente es útil para realizarla. Objetivos: Comparar propofol-fentanil en bolo con ketofol en infusión continua para colonoscopia. Método: Se realizó un estudio cuasiexperimental en 150 pacientes divididos en dos grupos. En el grupo propofol-fentanil se realizó inducción con fentanil 1,5-3 µg/kg más propofol 0,5-1,5 mg/kg y mantenimiento con bolos de propofol 0,4-0,5 mg/kg. En el grupo Ketofol se empleó una solución que se obtuvo al asociar 50 mL de propofol (1 por ciento) y 0,5 mL de ketamina (5 por ciento); dosis de carga de 1,1 mg/kg y mantenimiento con infusión continua manual. Se estudiaron variables hemodinámicas y respiratorias, nivel de sedación, satisfacción del paciente y del colonoscopista, tiempo de recuperación y eventos adversos. Resultados: La presión arterial media y la SpO2 mostraron diferencias entre los grupos y en los diferentes momentos, con cifras más bajas en el grupo propofol-fentanil. La frecuencia cardiaca no varió entre los grupos. La satisfacción de pacientes y los técnicos en endoscopias fue alta en ambas estrategias. Los pacientes del grupo propofol-fentanil tuvieron tiempo de recuperación superior (27 min). Menos de la mitad de los pacientes presentaron eventos adversos. El dolor, la insatisfacción y la depresión respiratoria fueron los más frecuentes. Conclusiones: Ketofol resultó superior a la asociación propofol-fentanil con mejor estabilidad hemodinámica y respiratoria, niveles de sedación más estables, satisfacción de pacientes y gastroenterólogos, tiempos de recuperación más breves, eventos adversos escasos y leves(AU)

Introduction: Colonoscopy is performed frequently, for which conscious sedation is useful. Objectives: To compare propofol-fentanyl bolus with ketofol continuous infusion for colonoscopy. Methods: A quasi-experimental study was performed in 150 patients divided into two groups. In the propofol-fentanyl group, induction was performed with fentanyl at doses 1.5-3 µg/kg plus propofol at doses 0.5-1.5 mg/kg and maintenance with propofol boluses at doses 0.4-0.5 mg/kg. In the ketofol group, a solution was used as obtained by associating 50 mL of propofol (1 percent) and 0.5 mL of ketamine (5 percent); loading dose of 1.1 mg/kg and maintenance with manual continuous infusion. Hemodynamic and respiratory variables were studied, together with sedation level, patient and colonoscopy technician satisfaction, recovery time and adverse events. Results: Mean arterial pressure and SpO2 showed differences between groups and at different times, with lower figures in the propofol-fentanyl group. The heart rate did not vary between the groups. Patients and endoscopy technician satisfaction was high in both strategies. Patients in the propofol-fentanyl group had longer recovery time (27 min.). Less than half of the patients presented adverse events. Pain, dissatisfaction and respiratory depression were the most frequent. Conclusions: Ketofol was higher to the propofol-fentanyl association with better hemodynamic and respiratory stability, more stable sedation levels, patient and gastroenterologist satisfaction, shorter recovery times, limited and mild adverse events(AU)

Application of conscious sedation analgesia in superficial bladder tumor resection for elderly patients / 实用医学杂志

Objective To evaluate the effects of conscious sedation analgesia during superficial bladder tumor resection for elderly patients. Methods Forty elderly patients who needed 2 μm laser resection for bladder tumors were treated with target controlled infusion (TCI) remifentanil and propofol. The initial target concentration of remifentanil was 2.5 ng/mL and that of propofol was 1 μg/mL. The target concentration of those two agents was adjusted until loss of painfulness to the operative stimulus. The MAP, HR, SpO2, RR and PetCO2, BIS and scores by OAA/S were compared between pre-and post-surgery at different time points (time before anesthesia, T0; time before analgesia, T1; time when the resection began, T2; 5 minutes after the resection began, T3;10 minutes after the resection began, T4; 15 minutes after the resection began, T5; the end of operation, T6;5 minutes after operation). Results All patients lived through the surgery under a conscious sedation. After the anesthesia, blood pressure, heart rate and breathing rate were declined, while oxygen saturation was unchanged. Conclusion TCI with remifentanil and propofol provides better hemodynamic stability, satisfactory sedation analgesia and faster recovery of surgery.

Monitored Anesthesia Care and Sedation/Analgesia Outside the Operating Room

In the modern era of medical practice, monitored anesthesia care (MAC) or sedation/analgesia in remote locations outside of the operating room has become a necessity, while working in a different environment poses additional challenge to the anesthesiologists. MAC minimizes anxiety, pain and discomfort during procedures or surgery under local anesthesia, resulting in improvement of patient's satisfaction and cooperation. Since complications associated with sedation are not rare, MAC or sedation/analgesia should be performed under appropriate circumstances and only when adequate resuscitative equipment and well-trained personnel are available. Anesthesia and procedural sedation outside of the operating room continue to show rapid growth, therefore, practical guidelines for sedation/analgesia are needed to improve quality of care and to provide a high level of patient safety and comfort.

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.