Abstract
BackgroundThe clinical efficacy of effect-site targeted patient-maintained propofol sedation (PMPS) compared to anaesthetist-controlled propofol sedation (ACPS) for patients undergoing awake joint replacement surgery is currently unknown. There is no commercially available medical device capable of delivering PMPS so we have designed and built such a device. We plan a clinical trial to compare PMPS to ACPS and to collect data relating to the safety of our prototype device in delivering sedation.MethodsThe trial is an open-label, randomised, controlled superiority trial recruiting adults who are undergoing elective primary lower-limb arthroplasty with sedation by propofol infusion by effect-site targeting into two equal-sized parallel arms: PMPS and ACPS. The primary research objective is to compare the body-weight-normalised rate of propofol consumption when sedation for surgery on adults undergoing elective primary lower-limb arthroplasty under spinal anaesthesia is patient-maintained versus when it is anaesthetist-controlled. The study primary null hypothesis is that there is no difference in the rate of propofol consumption when sedation is patient-maintained versus anaesthetist-controlled.DiscussionThis is the first trial to test the superiority of effect-site-targeted patient-maintained propofol sedation versus anaesthetist-controlled propofol sedation in terms of total propofol consumption during the sedation period. The results of this trial will help inform clinicians and device manufacturers of the clinical efficacy and safety of patient-maintained propofol sedation applied to a common operative setting.Trial registrationInternational Standard Randomised Controlled Trial Number Registry, ISRCTN29129799. Prospectively registered on 12 June 2018.
Highlights
The clinical efficacy of effect-site targeted patient-maintained propofol sedation (PMPS) compared to anaesthetist-controlled propofol sedation (ACPS) for patients undergoing awake joint replacement surgery is currently unknown
Sedation for lower limb arthroplasty is often provided by the supervising anaesthetist using propofol by intravenous computer-assisted target-controlled infusion (anaesthetist-controlled propofol sedation (ACPS)) [5]
A target-controlled infusion (TCI) device delivers a variable rate of propofol in order to obtain and maintain a specified effect-site drug concentration, until such time as a new concentration is set by the supervising anaesthetist
Summary
The clinical efficacy of effect-site targeted patient-maintained propofol sedation (PMPS) compared to anaesthetist-controlled propofol sedation (ACPS) for patients undergoing awake joint replacement surgery is currently unknown. Sedation for lower limb arthroplasty is often provided by the supervising anaesthetist using propofol by intravenous computer-assisted target-controlled infusion (anaesthetist-controlled propofol sedation (ACPS)) [5]. A target-controlled infusion (TCI) device delivers a variable rate of propofol in order to obtain and maintain a specified effect-site (i.e. brain) drug concentration, until such time as a new concentration is set by the supervising anaesthetist. Their use is standard anaesthesia practice in the UK
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