Sedation and regional anesthesia

Borgeat, Alain; Aguirre, José

doi:10.1097/aco.0b013e32832f3320

Cited by 18 publications

(11 citation statements)

References 37 publications

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“…It would be clinically advantageous for proper sedation with minimal side effects if the individual propofol Ce value incorporated with covariates rather than its average Ce of some population could be achieved. Yang showed that the decrease in propofol requirements for sedation during spinal anaesthesia was influenced by the block height, but not by the dose of local anaesthetic used [2]. This result is consistent with our established pharmacodynamic model in which the sensory block level rather than the dose of bupivacaine was proven to be a significant covariate.…”

Section: Discussionsupporting

confidence: 85%

“…Yang showed that the decrease in propofol requirements for sedation during spinal anaesthesia was influenced by the block height, but not by the dose of local anaesthetic used . This result is consistent with our established pharmacodynamic model in which the sensory block level rather than the dose of bupivacaine was proven to be a significant covariate.…”

Section: Discussionsupporting

confidence: 84%

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Modelling of the Sedative Effects of Propofol in Patients undergoing Spinal Anaesthesia: A Pharmacodynamic Analysis

Roh

Youngsoon

et al. 2016

Basic Clin Pharma Tox

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Sedation can increase patient comfort during spinal anaesthesia. Understanding the relationship between the propofol effect-site concentration (Ce) and patient sedation level could help clinicians achieve the desired sedation level with minimal side effects. We aimed to model the relationship between the propofol Ce and adequate and deep sedation and also incorporate covariates. Thirty patients scheduled for orthopaedic surgery received spinal anaesthesia with 0.5% bupivacaine. Propofol was administered via an effect-site target-controlled infusion device using the Schnider pharmacokinetic model. The pharmacodynamic models for both adequate sedation [Observer's Assessment of Alertness/Sedation (OAA/S) scores of 3-4] and deep sedation (OAA/S scores of 1-2) were developed using nonlinear mixed-effects modelling. Increments in the propofol Ce were associated with increased depths of sedation. In the basic model, the estimated population Ce 50 values for adequate and deep sedation were 0.94 and 1.52 lg/ml, respectively. The inclusion of the patient's age and sensory block level for adequate sedation and of age for deep sedation as covariates significantly improved the basic model by decreasing the objective function's minimum value from 10696.72 to 10677.92 (p = 0.0003). The simulated Ce 50 values for adequate sedation in 20-year-old patients with a T 12 sensory level and in 80-year-old patients with a T 4 level were 1.63 and 0.53 lg/ml, respectively. Both age and sensory block level should be considered for adequate sedation, and the propofol concentration should be reduced for elderly patients with a high spinal block to avoid unnecessarily deep levels of sedation.Propofol is one of the most commonly used drugs for sedation during spinal anaesthesia because of its rapid onset, easy titration and rapid offset. However, propofol frequently induces unnecessary deep sedation or side effects such as respiratory and cardiovascular depression because it has a narrow therapeutic range [1][2][3]. The use of a target-controlled infusion (TCI) system for propofol administration allows rapid induction and safe maintenance of the desired level of sedation, thereby making it ideal for technically demanding procedures [4][5][6]. Understanding the concentration-response relationship of sedation is fundamental for the safe use of propofol with incorporating factors influencing the sedative effect. However, few studies have evaluated the quantitative relationship between the effect-site concentration (Ce) of propofol and its sedative effect under spinal anaesthesia, although propofol is considered to induce sedation in a dose-dependent manner [7]. Therefore, we attempted to model the relationship between propofol Ce and sedation and also to characterize the covariates in the pharmacodynamic relationship between propofol Ce and adequate and deep sedation in patients undergoing spinal anaesthesia. Materials and MethodsStudy population. This study was approved by the ethics committee of the Yonsei University Health System (4...

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 84%

Modelling of the Sedative Effects of Propofol in Patients undergoing Spinal Anaesthesia: A Pharmacodynamic Analysis

Roh

Youngsoon

et al. 2016

Basic Clin Pharma Tox

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“…Rapid modifications could have been better controlled with the use of target-controlled infusion, where the administration is driven by microprocessor-controlled algorithms based on pharmacokinetic models. [ 20 21 ]…”

Section: Discussionmentioning

confidence: 99%

Comparison of subarachnoid block with bupivacaine and bupivacaine with fentanyl on entropy and sedation: A prospective randomized double-blind study

Varma

Darlong

Pandey

et al. 2014

J Anaesthesiol Clin Pharmacol

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Background and Aims:We studied the state entropy to monitor the sedative effect of subarachnoid block (SAB) using bupivacaine alone or combination of bupivacaine and fentanyl. The effect of use of fentanyl via the subarachnoid route on the sedation level was also studied using the entropy scores and the decrease in the requirement of propofol used as an adjuvant sedative drug.Materials and Methods:In this prospective randomized double-blind study, 30 patients of age 18-70 years requiring SAB were enrolled for the study. Patients with any known allergy to study drugs, contraindication for SAB, obesity, neurological or psychiatric disease on concurrent medication and refusal were excluded from the study. Patients were randomly allocated into two groups: Group C: SAB was administered with 2.5 mL (12.5 mg) of 0.5% hyperbaric bupivacaine; Group D: SAB was administered with 2.5 mL of 2 mL (10 mg) of 0.5% hyperbaric bupivacaine and 0.5 mL (25 μg) fentanyl. Propofol infusion was started if the state entropy (SE) value was ≥75, at the rate of 100 μg/kg/min till the SE value reaches in the range of 60-75 (recorded as onset time). Thereafter the infusion rate was titrated to maintain SE value between 60 and 75. The level of sedation was measured with SE and Ramsay sedation (RS) scale.Results:The demographic profile and baseline parameters, were comparable in two groups (P > 0.05). After SAB, decrease in SE and response entropy was noted in both the groups and fall was significant in Group D (P < 0.0001). The total propfol required in thew two groups were comparable being 3.97 ± 2.14 mg/kg in Group C and 3.41 ± 2.34 mg/kg in Group D (P = 0.342). The change in the mean RS values was from 1.17 ± 0.38 to 1.69 ± 0.47 in Group D (P = 0.06), whereas in Group C it was from 1.03 ± 0.18 to 1.43 ± 0.50 (P = 0.041) within 20 min of SAB.Conclusion:Subarachnoid block causes sedation per se, but the level of sedation is not clinically significant and the sedation caused is not enough to avoid sedative agents for allaying anxiety in patients intraoperatively. The sedative effect of SAB was enhanced by adding intrathecal fentanyl probably because of better quality of SAB. SE showed good correlation with RS scaling system. Therefore, SE may be used as reliable tool to titrate sedation in patients undergoing surgery under SAB.

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“…During the surgical procedure under regional anaesthesia, sedation is provided for patient comfort. To achieve adequate sedation without any haemodynamic or respiratory side effects, a state called conscious sedation is necessary . Conscious sedation is defined as a state of depressed consciousness using a sedative drug during which the patient should be able to respond to verbal command.…”

mentioning

confidence: 99%

Intrathecal fentanyl decreases the optimal effect site concentration of propofol during spinal anaesthesia

Lee

Kim

et al. 2014

Acta Anaesthesiol Scand

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Sedation and regional anesthesia

Cited by 18 publications

References 37 publications

Modelling of the Sedative Effects of Propofol in Patients undergoing Spinal Anaesthesia: A Pharmacodynamic Analysis

Modelling of the Sedative Effects of Propofol in Patients undergoing Spinal Anaesthesia: A Pharmacodynamic Analysis

Comparison of subarachnoid block with bupivacaine and bupivacaine with fentanyl on entropy and sedation: A prospective randomized double-blind study

Intrathecal fentanyl decreases the optimal effect site concentration of propofol during spinal anaesthesia

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