Patient-controlled sedation using propofol in elderly patients in day-case cataract surgery

Janzen, P. R. M.; Christys, A. R.; Vucevic, M.

doi:10.1093/bja/82.4.635

Cited by 54 publications

(37 citation statements)

References 6 publications

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“…Many drugs can be used for sedation during surgery under local anesthesia with monitored anesthesia care including opioids, benzodiazepines and propofol [5]. However, propofol may cause respiratory embarrassment [6]. Benzodiazepines may result in confusion and subsequent agitation, particularly in old age [7] and opioids are associated with increased risk of respiratory depression and oxygen desaturation [8].…”

Section: Introductionmentioning

confidence: 99%

Comparative study between dexmedetomidine/nalbuphine and midazolam/nalbuphine in monitored anesthesia care during ear surgery

Mohamed

Hakim

2014

Egyptian Journal of Anaesthesia

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Background: Monitored anesthesia care (MAC) is the practice of administrating local anesthesia in combination with IV sedatives, anxiolytics and/or analgesic drugs during certain surgical procedures. Most of ear surgeries can be done under monitored anesthesia care. Methodology: This is a randomized, double blind, prospective study and 100 patients undergoing ear surgery under MAC were divided into two groups of 50 patients each. The patients in group (D) received dexmedetomidine 1 lg/kg IV over 10 min followed by 0.7 lg/kg/h + nalbuphine 100 lg/kg IV and in group (M) received midazolam 20 lg/kg IV followed by 20 lg/kg/h + nalbuphine 100 lg/ kg over 10 min. Assessment of sedation by Ramsay sedation score, requirement of intraoperative rescue sedation, intraoperative VAS, intraoperative rescue analgesia, intraoperative hemodynamics, intraoperative bleeding, intraoperative complications, postoperative visual analogue score and postoperative rescue analgesia requirement, time to achieve full recovery and satisfaction scores of patients and surgeon were recorded. Results: Group (D) showed more sedation by Ramsay sedation score than the midazolam (M) group. Fifty percent in group (M) needed more rescue sedation than 26% in group (D) (p < 0.05). Intraoperative VAS was significantly higher in group (M) than in group (D) that led to the use of more rescue analgesia in 60% of group (M). Intraoperative heart rate and mean blood pressure were significantly lower in group (D) than in group (M) (p < 0.05). There was no statistical difference between the two groups as regards respiratory rate or SpO 2 . Intraoperative bleeding is less significantly less in group

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Section: Introductionmentioning

confidence: 99%

Comparative study between dexmedetomidine/nalbuphine and midazolam/nalbuphine in monitored anesthesia care during ear surgery

Mohamed

Hakim

2014

Egyptian Journal of Anaesthesia

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“…Ancak bu ajanlardan propofol, fazla sedasyon ve oryantasyon bozukluğuna, benzodiazepinler konfüzyona neden olabilirken, opioid ajanlar solunum depresyonu ve oksijen desatürasyonuna yol açmaktadır. Ayrıca, geriatrik hastalarda anestetik ilaçlarla intraoperatif hemodinaminin stabilize edilmesi ve sedasyon derinliğinin sağlanması da daha zordur (13,14 Grup II midazolamın etkisi 3 dakika içinde başlarken, deksmedetomidinin etkisinin en yüksek noktaya ulaşması, infüzyon sırasında 10 dakika içinde olur (16). Bu da, çalışmamızda, deksmedetomidin uygulanan grupta 10. dakikadan itibaren BIS değerlerindeki anlamlı düşüşü açıklamaktadır.…”

Section: Discussionunclassified

Comparison of Dexmedetomidine and Midazolam in Sedation for Percutaneous Hepatic Hydatid Cyst Drainage

Bavullu¹,

Aksoy²,

Abdullayev³

et al. 2013

Turk J Anesth Reanim

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Özgün Araştırma / Original Article 195Objective: Hydatid cyst still continues to be a public health problem. The basic treatment for the disease is surgery, but USG-guided percutaneous drainage has become an important treatment alternative. Agents preferred for sedation during drainage performed under local anaesthesia must also preserve respiration and haemodynamic stability while providing adequate sedation. We used midazolam, which has a short duration of action, and a selective α 2 adrenergic receptor agonist, dexmedetomidine, and compared them regarding their sedative properties and intraoperative complications. Methods:After approval by the clinical trials ethics committee, 40 patients with similar demographic data were randomized into two groups. All patients received 10 mg metochlopramide and 45.5 mg phenyramine before the procedure. Then midazolam (0.07 mg kg -1 iv bolus followed by 0.01 mg kg -1 h -1 infusion) was administered to Group 1, and dexmedetomidine (1 µg kg -1 loading dose in 10 minutes, followed by 0.2 µg kg -1 h -1 continuous infusion) was administered to Group 2 for sedation. Just before the surgical procedure, all patients received propofol in a subhypnotic dose of 0.5 mg kg -1 iv. Propofol 0.5 mg kg -1 iv was administered to patients in each group if there was no adequate sedation. OAA/S and BIS scales were used to evaluate the sedation level during the procedure. HR, MAP, RR, SpO 2 and ETCO 2 values were monitored before and after induction and every 5 minutes thereafter. The propofol requirement was noted for each group.Results: Sedation in the dexmedetomidine group was as effective and adequate as that observed with the midazolam group. BIS values were significantly low in the dexmedetomidine group, especially after 10 minutes and thereafter. Respiratory rate, SpO 2 , and ETCO 2 values were similar in both groups, whereas clinically insignificant decreases in HR and MAP were observed in the dexmedetomidine group. Propofol requirements were similar in both groups. Conclusion:We conclude that dexmedetomidine can be an appropriate agent in surgical procedures performed under local anaesthesia, providing adequate sedation without respiratory depression.Key Words: Dexmedetomidine, midazolam, sedation Amaç: Kist hidatik hala önemli bir sağlık sorunu olmaya devam etmektedir. Temel tedavisinin cerrahi olması ile birlikte, günümüzde ultrasonografi eşliğinde yapılan perkütan drenaj da önemli bir tedavi alternatifi haline gelmiştir. Lokal anestezi altında yapılan bu işlem sırasında, sedasyon için tercih edilecek ajanlar, hastada yeterli sedasyonu sağlamanın yanı sıra solunumu ve hemodinamiyi en az düzeyde etkileyecek özellikte olmalıdır. Çalışmamızda kısa etkili bir benzodiazepin olan midazolamı ve α 2 selektif adrenerjik reseptör agonisti deksmedetomidini kullanarak, bu ajanları sedasyon derinliği ve intraoperatif komplikasyonlar açısından karşılaştırdık.Yöntemler: Etik kurul onayı ve hasta onamı alındıktan sonra demografik verileri benzer 40 hasta, randomize iki gruba ayrıldı. İşlem öncesi her...

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“…Bu tekniğin oftalmik cerrahide başarılı uygulamaları değişik çalışmalarda rapor edilmiştir (43)(44)(45). Bu tekniğin temel avantajı artmış hasta memnuniyetidir.…”

Section: Hasta Kontrollü Sedasyon Ve Analjeziunclassified

The role of sedation on cataract surgery

Önder¹,

Tekelioğlu²,

Demırhan³

et al. 2013

Turk J Bioch

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Topikal anestezi, saydam kornea kesisinden yapılan fakoemülsifikasyon katarakt cerrahisi için genellikle yeterli ve etkin oküler anestezi sağlamaktadır. Ancak aşırı endişeli, kaygılı ve kooperasyonu güç olan olgularda intraoperatif problemlerle karşılaşma hiç de azımsanmayacak kadar çok-tur. Bu olgularda uygulanan oral veya intravenöz sedasyon, bu problemleri büyük oranda ortadan kaldırmaktadır. Bu derlemenin amacı, saydam kornea kesisinden yapılan fakoemülsifikasyon katarakt cerrahisinde sedasyonun rolü ve olası sedasyon alternatiflerinin değerlendirilmesidir.Topical anesthesia for clear corneal phacoemulsification cataract surgery usually provides adequate and effective ocular anesthesia. However, the possibility of intraoperative complications is not rare in anxious, distressed and uncooperative patients. In these cases, oral or intravenous sedation largely eliminates these problems. The purpose of this review is to evaluate the role of sedation in cataract surgery and possible sedation alternatives.Anahtar Kelimeler: katarakt cerrahisi, sedasyon.

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Patient-controlled sedation using propofol in elderly patients in day-case cataract surgery

Cited by 54 publications

References 6 publications

Comparative study between dexmedetomidine/nalbuphine and midazolam/nalbuphine in monitored anesthesia care during ear surgery

Comparative study between dexmedetomidine/nalbuphine and midazolam/nalbuphine in monitored anesthesia care during ear surgery

Comparison of Dexmedetomidine and Midazolam in Sedation for Percutaneous Hepatic Hydatid Cyst Drainage

The role of sedation on cataract surgery

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