Abstract
Abstract It is widely known the need for a high quality sedation associated with local regional anesthesia in elderly patients’ surgery. The aim of this study was to compare two sedation regimes: propofol and midazolam, associated to spinal anesthesia with isobaric 0.5% bupivacaine in lower abdominal surgery in elderly patients. After obtaining the informed consent, 60 patients aged between 65 and 82 years old (ASA I-III), scheduled for unilateral hernioplasty , under spinal anesthesia with isobaric bupivacaine 1,5 ml (0.5%), were randomized into two groups of 30 patients each: P group - patients received propofol 3mg/kg/body/hour in the first 10 minutes and then continuous infusion by injection of 1,8 mg/kg/body/hour, and group M-patients who have received midazolam 0,2mg/kg/body/hour in the first 10 minutes and then continuous infusion by injection of 0,15 mg/kg/body/hour. In order to achieve a similar level of sedation we used 0,1% midazolam infusion and 1% propofol. Intraoperative, the following have been monitored: heart rate and breath, mean arterial pressure, hemoglobin oxygen saturation. We have also recorded the sedation score (modified Wilson sedation scale), awakening times, patient satisfaction at 24 hours (satisfaction score according to Iowa University). The average score of sedation for group P was of 3,24 ± 0,23, compared to 2,64 ±0,42 in group M (p = 0.001). Both drugs reduce blood pressure, but not more than 20% of the initial value. There are no significant differences in the satisfaction score of the patient (p = 0,18). There was just one case of respiratory depression in group M with the decrease of SpO2 at 86%.Sedation with propofol associated with local regional anesthesia techniques in elderly patients seems to provide better conditions in terms of sedation score and lack of respiratory depression compared with the administration of midazolam. Recovery was significantly faster after sedation with propofol. The satisfaction score of the patient was similar in the two groups
Highlights
Defining sedation as “a state of calm and tranquility” induced by medication known to have sedative effect, Johan Raeder has recently conducted a relevant analysis of various situations experienced by the patient and the physician to determine the optimal degree of sedation required for each patient, without being able to give the ideal recipe for sedation.The need to associate a high quality, secure and fast elimination sedation, it is widely known for regional anesthesia
The aim of this study was to see whether the administration of sedative doses of propofol, respectively of midazolam (iv.), both associated to spinal anesthesia with isobaric 0.5% bupivacaine in lower abdominal surgery in elderly patients: a) suppresses anxiety during surgery in elderly patients; b) determines changes in the hemodynamic behavior; c) depresses breathing changing pulse oximetry; d) there are differences in the level of sedation; e) there are differences in the awaking times and satisfaction in 24 hours
During the period February 1st, 2012 – September 1st, 2012 we have included 60 elderly patients proposed for surgery, under spinal anesthesia with 1.5 ml 0,5% isobaric bupivacaine in a prospective randomized observational study approved by the Ethics Committee of the County Emergency Hospital Constanta
Summary
Defining sedation as “a state of calm and tranquility” induced by medication known to have sedative effect, Johan Raeder has recently conducted a relevant analysis of various situations experienced by the patient and the physician to determine the optimal degree of sedation required for each patient, without being able to give the ideal recipe for sedation.The need to associate a high quality, secure and fast elimination sedation, it is widely known for regional anesthesia. Defining sedation as “a state of calm and tranquility” induced by medication known to have sedative effect, Johan Raeder has recently conducted a relevant analysis of various situations experienced by the patient and the physician to determine the optimal degree of sedation required for each patient, without being able to give the ideal recipe for sedation. The aim of this study was to see whether the administration of sedative doses of propofol, respectively of midazolam (iv.), both associated to spinal anesthesia with isobaric 0.5% bupivacaine in lower abdominal surgery in elderly patients: a) suppresses anxiety during surgery in elderly patients; b) determines changes in the hemodynamic behavior; c) depresses breathing changing pulse oximetry; d) there are differences in the level of sedation; e) there are differences in the awaking times and satisfaction in 24 hours
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