Comparison of Propofol Administration Techniques for Sedation During Monitored Anesthesia Care

Abstract

Sixty-three outpatients undergoing breast biopsy procedures with local anesthesia were randomly assigned to receive propofol by intermittent bolus injections (n = 21), a conventional syringe infusion pump (n = 21), or a target-controlled infusion (TCI) device (n = 21) for intraoperative sedation. In the first two groups, an initial intravenous (IV) bolus of propofol (0.3 mg/kg) was administered and an attempt was made to maintain the sedation level at an Observer's Assessment of Alertness/Sedation (OAA/S) score of 3 or 4 with either intermittent bolus injections of propofol (10 mg) or a variable-rate infusion (25-100 micrograms.kg-1.min-1). In the TCI group, the initial target concentration of propofol was set at 2 micrograms/mL and the target concentration was adjusted between 1 and 4 micrograms/mL in an attempt to maintain an OAA/S score of 3 or 4. Recovery was assessed using clinical criteria, visual analog scales (VAS), and the digit-symbol substitution test (DSST). The overall quality of sedation, operating conditions, and clinical recovery profiles were similar in all three treatment groups. The anesthesiologist had to intervene more frequently in the intermittent bolus injection group than in the two infusion groups. We conclude that the use of an infusion technique may allow the anesthesiologist more time for monitoring the patient by decreasing the number of interventions necessary to administer supplemental doses of the sedative medication during the operation. However, the cost of the IV drug delivery system may become an increasingly important factor in the future.

Clinical assessment of target-controlled infusion of propofol during monitored anesthesia care

“…Previous studies evaluating different techniques of propofol administration during monitored anesthesia care demonstrated that, although the overall quality of sedation, operating conditions and clinical recovery profiles were similar with different administration techniques, the anesthesiologist had to intervene more frequently with the intermittent bolus injection technique than either conventional syringe infusion or target-controlled infusion techniques. 17 While it has been reported in large multicentre trials, that target-controlled infusion systems are easily learned and well accepted by anesthesiologists in their daily practice) 8 A wide variety of objective clinical scoring systems has been developed to reduce individual observer bias and to provide a more consistent method of monitoring temporal changes in the level of sedation. 19 The scale used in the present investigation, to evaluate the depth of sedation, is based on assessment in four separate categories (responsiveness, speech, facial expression and ocular appearance) and has been demonstrated to provide a high discriminatory power of the different levels of sedation.…”

Remifentanilversus propofol for radio frequency treatment of atrial flutter

“…In Group P, agitation that could have hampered the procedure 15 was not observed at the achieved level of sedation. However, agitation has been reported by Newson et al 16 during mammary biopsy under propofol and local anesthesia.…”

Monitored Anaesthesia Care in An One Hundred Years Old Man in NIO&H

“…intermittent boluses, variable rate infusion, target controlled infusion, patient controlled sedation. 6,7 The most commonly used sedation technique is a small dose of midazolam(1-2mg) or propofol (0.5-1 mg/kg) or both followed by a propofol infusion at 25 to 100µg/kg/min. 8 Avramov and White 9 described the combined use of alfentanil (0.3 to 0.4 µg/kg/min) and propofol (25-75 µg/kg/min) infusion for MAC.…”