Patient-Controlled Sedation for Local Anesthesia Patients in Plastic Surgery

Kim, Dong Hee; Eum, Hyun Sik; Sohn, Byung Kyu

Abstract

BACKGROUND
Patient-controlled sedation (PCS) involves the patient self administering the sedative agent to the point at which the patient is satisfied with the level of sedation with the advantage to overcome the phamacodynamic differences between individual patients. We performed the PCS with two different dosages of propofol and compared the efficacy and side effects for local anesthesia patients in plastic surgery.
METHODS
Thirty patients underwent propofol PCS with Perfusor fm (B. Braun, Germany) PCA pump during nasal inhalation of O2 3 L/min with continuous monitoring of SpO2. PCS settings were 10 mg of bolus dose, 30 mg of initial loading dose, 1 min of lockout interval, 100 mg/hr of continuous infusion in group 1 and 20 mg of bolus dose, 60 mg of initial loading dose, 1 min of lockout interval, 100 mg/hr of continuous infusion in group 2. All the patients received local anesthesia with 1% lidocaine before operation. Observer's assessment of alertness/sedation (OAA/S) scale, SpO2, mean infusion rate of propofol, duration of induction and recovery, recall of operative procedure, and patient's and surgeon's satisfaction were checked.
RESULTS
The mean infusion rate (group 1; 32.2 +/- 19.4, group 2; 38.3 +/- 20.5 ug/kg/min), duration of induction (group 1; 4.9 +/- 1.9, group 2; 3.1 +/- 1.4 min), duration of recovery (group 1; 1.7 +/- 1.2, group 2; 2.5 +/- 1.3 min), and mean OAA/S scale (group 1; 3.8 +/- 1.6, group 2; 3.1 +/- 1.5) were not significantly different between the groups (mean +/- SD). Inadequate sedation occurred more frequently in group 1 (13%) than group 2 (0%), and incidences of respiratory depression (SpO2 < 95%) were more higher in group 2 (20%) than group 1 (0%). Numbers of satisfaction of patient and surgeon were 100% and 87% in group 1, and 87% and 93% in group 2.
CONCLUSIONS
10 mg or 20 mg as a bolus dose and 30 mg or 60 mg as a initial loading dose of propofol for PCS provided effective sedation and patient's and surgeon's satisfaction without significant side effect for local anesthesia patients in plastic surgery. (Korean J Anesthesiol 2004; 46: 583~588)