Patient-Controlled Sedation During Epidural Anesthesia

Abstract

The purpose of this study was to evaluate the feasibility and advantages or disadvantages, if any, of patient-controlled sedation compared with sedation administered by the anesthesiologist during surgical epidural anesthesia. Forty patients were divided at random into two groups with 20 patients in each group. Patients in group 1 received 0.5-1.0 mg intravenous midazolam and 25-50 micrograms intravenous fentanyl in increments administered by the anesthesiologist to achieve intraoperative sedation; patients in group 2 self-administered a mixture of midazolam (0.5 mg) and fentanyl (25 micrograms) in increments using an Abbott Lifecare PCA infuser to achieve sedation. Demographics of the patients, the types of surgery performed, doses of midazolam and fentanyl administered in a given period of time, and the level of sedation maintained during epidural anesthesia and surgery were similar in both groups. Patients in the self-administered group, however, rated their level of comfort during anesthesia and surgery higher than did those in the anesthesiologist-controlled sedation group. This could have been due to a positive psychological effect produced by allowing patient to feel that they have some control over their situation. The findings of this study indicate that patient-controlled sedation using a combination of midazolam and fentanyl is a safe and effective technique that provides intraoperative sedation ranked better by patients than that provided by anesthesiologists using the same drugs. More studies are, however, needed to determine the best choice of drug(s), the doses, the lock-out intervals, and the possible use of continuous infusion with patient-controlled sedation.

Patient-controlled intravenous analgesia using remifentanil in the parturient

“…[2][3][4][5][6]8 With the PCIA system, the patient benefits from a greater sense of control over her pain management, an important psychological effect which contributes to the success of this technique. 9 We did not observe side effects in babies but all neonates were 36 wk old or more.…”

Patient-controlled sedation vs. anaesthetic nurse-controlled sedation for cataract surgery in elderly patients

“…All of the patients in the ACS group were administered bolus dose of propofol. The median (range) frequency of delivery was five (2)(3)(4)(5)(6)(7)(8) and four (0-18) in groups ACS and PCS, respectively. The delivery/demand ratio was 74% and 54% in the ACS and the PCS groups, respectively.…”

“…Continuous intravenous infusion of sedative drugs can be disastrous in elderly patients (5) and patient-controlled sedation (PCS) might have advantage with regard to patients' safety (6,7).…”

Patient-controlled sedation in procedural care

“…PCS is a relative young field for research. Park et al (1991) [42] stated that PCS using midazolam and fentanyl during surgical epidural anaesthesia was ranked higher by patients than sedation provided by anaesthetists. Rudkin et al (1991) [43] initiated the use of propofol PCS for patients undergoing third molar extraction under local analgesia and showed that doses of propofol were dependent on the duration of the procedure and the difficulty of the surgery.…”