Sedação Controlada pelo Paciente em Cirurgia Ortopédica sob Anestesia Regional: uma Nova Abordagem em Sedação

Ekin, Abdulselam; Donmez, Ferah; Taspinar, Vildan; Dikmen, Bayazıt

doi:10.1016/j.bjan.2012.07.012

Cited by 8 publications

(4 citation statements)

References 20 publications

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“…This compares to 41 (2.3, 94.3) mg/hr in the current study, where the sedation was patient controlled. Ekin et al [14] equally reported lower doses of self-administered propofol in their study compared to our pilot study. As a whole, this suggests that the lower sedation doses in the IVR group seen in the pilot study was not the result of IVR, but a lower overall sedation requirement than what was administered as a routine by the anesthesiologist.…”

Section: Discussionsupporting

confidence: 43%

“…Each press of the PCS supplied a propofol bolus of 400mcg/kg Ideal Body Weight with a 5-minute lockout period. To prevent unwanted hypotension documented in previous studies [14] and on the advice from anesthesiologists reviewing the study protocol, an upper limit of 30mg per bolus was put in place as an additional safeguard. Anesthesiologists were advised that PCS should be the primary form of sedation but were not limited in giving additional sedation or analgesia if required in their clinical judgement.…”

Section: Methodsmentioning

confidence: 99%

“…Patient controlled sedation (PCS) has been reported as early as 2013 to confer benefits during regional anesthesia [14], specifically allowing patients to control their own depth of sedation to ensure comfort without increasing complications. Ekin et al reported the successful use of PCS during joint replacement surgery using a 400 mcg/kg bolus and a 5-minute lockout, demonstrating a mean usage of 133 mg of propofol over the duration of a procedure in 30 patients [14]. A recent review demonstrated the safety and efficacy of PCS, with a reduced risk of rescue interventions for sedation-related adverse events [15].…”

Section: Introductionmentioning

confidence: 99%

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

2020

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Background Immersive 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 selfadministered sedation requirements of patients undergoing joint replacement surgery under regional anesthesia in a single center. Methods and findings This 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. Conclusions In patients receiving joint replacement surgery under regional anesthesia with PCS, IVR was well tolerated but did not decrease the overall sedation requirement.

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Section: Discussionsupporting

confidence: 43%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

2020

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“…Lower-limb orthopedic surgery is frequently performed with regional anesthesia (23). Despite several advantages, those surgeries are associated with discomfort and worry for the patients.…”

Section: Discussionmentioning

confidence: 99%

Use of pre‑operative anxiety score to determine the precise dose of butorphanol for intra‑operative sedation under regional anesthesia: A double‑blinded randomized trial

et al. 2019

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A randomized double-blinded controlled trial was performed to explore the association between pre-operative anxiety and intra-operative butorphanol requirement to evaluate the precise sedative requirement and to confirm the sedative effect of butorphanol in patients receiving lower-limb orthopedic surgery. The Amsterdam pre-operative anxiety and information scale and the Ramsay sedation score (RSS) were used to assess the patients' pre-operative anxiety score and sedation state during surgery. Patients were divided into two groups according to their pre-operative anxiety score prior to administration of pre-medication. Patients in each group were randomly divided into a butorphanol group and a 0.9% saline group. A total of 142 patients were enrolled and 131 patients were analyzed. The sedation scores of patients with high pre-operative anxiety in the 0.9% saline group were lower than those in the butorphanol group at each time-point after infusion. An increased pre-operative anxiety score predicted an increased duration to reach an RSS of 4 for an acceptable level of sedation (r2=0.887, P<0.0001). In conclusion, butorphanol had a good sedative effect on patients with pre-operative anxiety. The following formula was proposed: Precise dose of butorphanol (µg/kg)=15.26 + (0.14× pre-operative anxiety score), which may provide an improvement for patients exhibiting a high level of pre-operative anxiety. The trial was registered prior to patient enrollment at on 20.01.2018 (trial registration no. NCT03429179).

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Intravenous Drugs for Sedation: Target-Controlled, Patient-Controlled and Patient-Maintained Delivery

Anderson

2017

Total Intravenous Anesthesia and Target Controlled Infusions

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Sedação Controlada pelo Paciente em Cirurgia Ortopédica sob Anestesia Regional: uma Nova Abordagem em Sedação

Abstract: This study suggests that patient-controlled sedation with propofol can be used efficiently in orthopedic procedures.

Cited by 8 publications

References 20 publications

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

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

Use of pre‑operative anxiety score to determine the precise dose of butorphanol for intra‑operative sedation under regional anesthesia: A double‑blinded randomized trial

Intravenous Drugs for Sedation: Target-Controlled, Patient-Controlled and Patient-Maintained Delivery

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