Propofol Patient-controlled Sedation Research Articles

Effects of immersive virtual reality therapy on intravenous patient-controlled sedation during orthopaedic surgery under regional anesthesia: A randomized controlled trial.

BackgroundImmersive virtual reality (IVR) is a form of distraction therapy that has shown potential as an analgesia and sedation sparing agent. This study assessed the effect of IVR on the self-administered sedation requirements of patients undergoing joint replacement surgery under regional anesthesia in a single center.Methods and findingsThis study was a single-center, randomized control trial at St Vincent’s Hospital in Melbourne, Australia. Fifty patients undergoing elective total knee and total hip arthroplasty were randomized to IVR and Propofol patient-controlled sedation (PCS) or propofol PCS alone. The primary outcome measure was intra-operative propofol use. Secondary outcomes included pattern of propofol use over time, use of adjunct analgesia, unmet propofol demand, and patient satisfaction survey scores. Of 50 total patients, 25 received IVR in conjunction with PCS, and 25 received PCS alone. All patients received adjunct analgesia from the treating Anesthesiologist. Median propofol use/hour over the entire procedure in the control group was 40 (11.1, 93.9) mg/hour compared with 45 (0, 94.7) mg/hour in the IVR group (p = 0.90). There were no differences in patterns of propofol use over the course of each procedure. Adjusting for various baseline characteristics did not change the results. Postoperative satisfaction scores were equivalent in both groups. The VR intervention was well tolerated by all patients, with no report of major side effects. Key limitations were relatively small sample size, the non-blinded nature of the study, and use of adjunct analgesia.ConclusionsIn patients receiving joint replacement surgery under regional anesthesia with PCS, IVR was well tolerated but did not decrease the overall sedation requirement.

The effect of audiovisual distraction on patient-controlled sedation under spinal anesthesia: a prospective, randomized trial.

Audiovisual distraction (AVD) has been used to augment or replace procedural sedation. We investigated whether AVD in patients having total hip (THA) or total knee arthroplasty (TKA) under spinal anesthesia would reduce self-administered propofol consumption during surgery. 50 participants were randomized equally into a patient-controlled sedation (PCS) group or AVD group. All participants were given a spinal block and a propofol PCS device prior to surgery. In addition, Group AVD participants selected and watched a movie or documentary film on a tablet device with noise-cancelling headphones during surgery. The primary outcome of this study was total propofol consumption standardized as mcg/kg/min. Secondary outcomes evaluated increased supplemental oxygen use, rescue airway interventions, hypotension, disruptive movement events during surgery, sedation, and satisfaction with anesthesia scores. Historical clinician-controlled propofol usage at our institution over the previous 2 years were recorded. There was no significant difference in median propofol consumption between Groups PCS and AVD, 8.4mcg/kg/min (1.6-18.9) vs 4mcg/kg/min (0-9) (P = 0.29), respectively. Historical clinician-controlled usage of propofol demonstrated a median of 39.3mcg/kg/min (29.2-51.2). There were few differences in the secondary outcome measures. The use of AVD did not reduce patient-controlled propofol consumption in patients having a THA or TKA surgery under spinal anesthesia.

Patient-controlled sedation with propofol for endoscopic procedures-A cost analysis.

Patient-controlled sedation (PCS) with propofol accompanied by a bedside nurse anaesthetist is an alternative sedation method for endoscopic procedures compared with midazolam administered by a nurse or endoscopist. Increasing costs in health care demands an economic perspective when introducing alternative methods. We applied a hospital perspective on a cost analysis comparing different methods of sedation and the resource use that were expected to affect cost differences related to the sedation. Based on two randomised previous studies, the direct costs were determined for different sedation methods during two advanced endoscopic procedures: endoscopic retrograde cholangiopancreatography (ERCP) and flexible bronchoscopy including endobronchial ultrasound. ERCP comparisons were made between midazolam sedation by the endoscopic team, PCS with a bedside nurse anaesthetist and propofol sedation administered by a nurse anaesthetist. Bronchoscopy comparisons were made between midazolam sedation by the endoscopic team and PCS with a bedside nurse anaesthetist, categorised by premedication morphine-scopolamine or glycopyrronium. Propofol PCS with a bedside nurse anaesthetist resulted in lower costs per patient for sedation for both ERCP (233 USD) and bronchoscopy (premedication morphine-scopolamine 267 USD, premedication glycopyrronium 269 USD) compared with midazolam (ERCP 425 USD, bronchoscopy 337 USD). Aborted procedures that needed to be repeated and prolonged hospital stays significantly increased the cost for the midazolam groups. Propofol PCS with a bedside nurse anaesthetist reduces the direct sedation costs for ERCP and bronchoscopy procedures compared with midazolam sedation.

A Randomized Controlled Trial Comparing Patient-Controlled and Physician-Controlled Sedation in the Emergency Department

We compare patient-controlled sedation (PCS) and emergency physician-controlled sedation (EPCS) with respect to propofol requirements, depth of sedation, adverse events, recovery time, physician satisfaction, and patient satisfaction in emergency department (ED) patients requiring brief but painful procedures. One hundred sixty-six patients in this randomized controlled trial received propofol sedation according to one of 2 regimens: infusion of propofol at doses determined by the treating physician (EPCS group) or infusion of propofol with a patient-controlled infusion pump (PCS group). The PCS group received an initial physician-controlled bolus following by self-administered doses. Depth of sedation was assessed at 3-minute intervals. Adverse events were recorded as they occurred. Physician and patient satisfaction were recorded with 100-mm visual analog scales. There was a nonsignificant trend toward lower total propofol doses with PCS relative to EPCS (medians 1.36 versus 1.60 mg/kg, respectively; median difference -0.15 mg/kg; 95% confidence interval of the difference -0.33 to 0.05 mg/kg; P=.14). Adverse events, requirement for treatment of adverse events, and recovery time did not differ in the 2 groups. Depth of sedation was lower in the PCS group. Procedural success, ease of procedure, and patient satisfaction were similar in both groups despite nearly twice as many patients recalling the procedure in the PCS group and 15% of patients requiring additional physician-administered doses in the PCS group. Compared with EPCS, PCS demonstrated similar propofol dosing, safety, recovery, and satisfaction but resulted in lighter sedation. Propofol PCS appears safe and effective for ED procedures requiring moderate rather than deep sedation.

Propofol Infusion and the Potential Use of Propofol Patient-Controlled Sedation (PCS) in Terminally 111 Patients

AbstractSedation in end-of-life care is an accepted, but nonetheless controversial, means of providing relief from otherwise refractory and intolerable symptoms and distress. For purposes of this article, the terms ‘palliative sedation’ and ‘patient-controlled palliative sedation’ (PCS) will be used to describe clinician-controlled or patient-controlled drug delivery. Ideally, therapy should improve symptoms without unfavorably affecting the patient's level of perception or capacity to communicate with friends and family members. Benzodiazepines, opioids, and certain neuroleptics have been used for palliative sedation with variable success and satisfaction rates. Propofol is a sedative-anesthetic with unique pharmacological properties which may prove highly desirable for use in selected terminally ill patients. There are few case reports and studies about using propofol as a continuous infusion for palliative sedation. Propofol-PCS has been used for sedation in certain surgical procedures in both young an...

Effect‐site targeted patient‐controlled sedation with propofol: comparison with anaesthetist administration for colonoscopy

Patient-controlled sedation (PCS) allows patients to match their sedation requirement to perceived discomfort. The significant delay in onset of sedation may be overcome with effect-site steered target controlled infusion, but previously only trials in volunteers have been carried out. We therefore conducted a randomised, double-blind controlled trial comparing effect-site steered propofol PCS with anaesthetist-administered propofol sedation in 40 patients presenting for colonoscopy. The initial effect-site target in the PCS group was 0.8 microg.ml(-1), increment was 0.1 microg.ml(-1) and lockout was 3 min. Patient and endoscopist satisfaction and operating conditions were similar between the two groups. PCS patients were sedated more slowly (13 [7.1] vs. 3 [1.1] min; p < 0.0001) and less deeply (minimum BIS value: 71 [16] vs. 58 [15]; p = 0.13) than anaesthetist-administered propofol sedation patients. More of the latter patients were hypotensive, but all patients had similar recollection of events during the procedure and similar quality of recovery.

Propofol Infusion and the Potential Use of Propofol Patient-Controlled Sedation (PCS) in Terminally 111 Patients

Propofol Infusion and the Potential Use of Propofol Patient-Controlled Sedation (PCS) in Terminally 111 Patients

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

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 (10mg 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

Patient-Controlled Sedation for Local Anesthesia Patients in Plastic Surgery

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 fm (B. Braun, Germany) PCA pump during nasal inhalation of 3 L/min with continuous monitoring of . 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, , 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 (

Patient-controlled sedation with propofol for colonoscopy

Background: Patient-controlled sedation (PCS) allows the patient to titrate the dosage of sedative drugs according to need. Methods: To compare the efficacy of PCS by using propofol with anesthetist-administered midazolam during colonoscopy, 88 patients were randomized to receive either intravenous midazolam 0.05 mg/kg bolus (1 mg increments as required) or propofol PCS (0.3 mg/kg bolus, zero lockout). Heart and respiratory rates, blood pressure, and oxygen saturation were monitored. Patient cooperation, endoscopist satisfaction, and level of sedation were scored. Patient satisfaction was assessed by questionnaire. To correct for multiple testing of data, statistical significance was asserted only for individually stated p values with p < 0.01. Results: Oxygen saturation and hemodynamics were stable in both groups. Better patient cooperation (good vs. minimal; p = 0.008) and higher endoscopist satisfaction (very good vs. good; p = 0.001) were achieved with PCS. Although more sedated intraoperatively (sedation score 4 vs. 2; p = 0.03 for a single test of hypothesis; correction for multiple testing of data removes this significance), patients in the propofol PCS group were more alert by 30 minutes and discharged earlier (mean and SD times were 43.3 [12.1] min compared with 61.0 [29.7] min; p = 0.001.) More patients in the PCS group (86 vs. 6l%; p < 0.001) were satisfied with their overall level of comfort. Conclusion: PCS with propofol is effective and results in high patient satisfaction and faster discharge. (Gastrointest Endosc 2001;54:8-13.)

Propofol Patient-Controlled Sedation During Hip or Knee Arthroplasty in Elderly Patients

Purpose Little information is available regarding the use of patient-controlled sedation (PCS) among the elderly. This study evaluated the safety and efficacy of propofol PCS among elderly patients undergoing hip or knee arthroplasty.

Propofol Sedation During Awake Craniotomy for Seizures

This prospective study evaluated the safety and efficacy of patient-controlled sedation (PCS) using propofol during awake seizure surgery performed under bupivacaine scalp blocks. Thirty-seven patients were randomized to receive either propofol PCS combined with a basal infusion of propofol (n = 20) or neurolept analgesia using an initial bolus dose of fentanyl and droperidol followed by a fentanyl infusion (n = 17). Both groups received supplemental fentanyl and dimenhydrinate for intraoperative pain and nausea, respectively. Comparisons were made between groups for sedation, memory, and cognitive function, patient satisfaction, and incidence of complications. Levels of intraoperative sedation and patient satisfaction were similar between groups. Memory and cognitive function were well preserved in both groups. The incidence of transient episodes of ventilatory rate depression (<8 bpm) was more frequent among the propofol patients (5 vs 0, P = 0.04), particularly after supplemental doses of opioid. Intraoperative seizures were more common among the neurolept patients (7 vs 0, P = 0.002). PCS using propofol represents an effective alternative to neurolept analgesia during awake seizure surgery performed in a monitored care environment. (Anesth Analg 1997;84:1285-91)