Variables Influencing the Depth of Conscious Sedation in Plastic Surgery: A Prospective Study

Abstract

BackgroundConscious sedation has been widely utilized in plastic surgery. However, inadequate research has been published evaluating adequate drug dosage and depth of sedation. In clinical practice, sedation is often inadequate or accompanied by complications when sedatives are administered according to body weight alone. The purpose of this study was to identify variables influencing the depth of sedation during conscious sedation for plastic surgery.MethodsThis prospective study evaluated 97 patients who underwent plastic surgical procedures under conscious sedation. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, and glucose levels were measured. Midazolam and ketamine were administered intravenously according to a preset protocol. Bispectral index (BIS) recordings were obtained to evaluate the depth of sedation 4, 10, 15, and 20 minutes after midazolam administration. Associations between variables and the BIS were assessed using multiple regression analysis.ResultsAlcohol intake and female sex were positively associated with the mean BIS (P<0.01). Age was negatively associated with the mean BIS (P<0.01). Body mass index (P=0.263), creatinine clearance (P=0.832), smoking history (P=0.398), glucose (P=0.718), AST (P=0.729), and ALT (P=0.423) were not associated with the BIS.ConclusionsOlder patients tended to have a greater depth of sedation, whereas females and patients with greater alcohol intake had a shallower depth of sedation. Thus, precise dose adjustments of sedatives, accounting for not only weight but also age, sex, and alcohol consumption, are required to achieve safe, effective, and predictable conscious sedation.

The impact of female sex on anaesthetic awareness, depth and emergence: A systematic review and meta-analysis

“…The other two studies reported sedation level for given drug dose of midazolam 42 or midazolam and ketamine. 60 They both found that sedation levels were lighter in females than in males for their given drug protocols.…”

“…The other two studies reported sedation level for given drug dose of midazolam 42 or midazolam and ketamine. 60 All rights reserved. No reuse allowed without permission.…”

“…These included randomised controlled trials (RCTs) (23 of 64), 34, non-randomised interventional trials (19 of 64), [59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77] and cohort studies (22 of 64). 4,9,17,18,20,[78][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93][94] Studies were conducted in 20 countries, including four multi-national studies, 9,17,18,34 studies were fair quality with some concerns for bias, the most common reasons being lack of blinding of assessors to outcome or study groups.…”