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

Yun, Mi Ja; Oh, Ah Young; Kim, K. O.; Kim, Y. H.

doi:10.1111/j.1742-1241.2007.01544.x

Cited by 16 publications

(10 citation statements)

References 22 publications

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“…They found this ratio to be closer to one in the PCS/fuzzy-control group compared with the physician administered analgesia group. This is in contrast to Yun who found a higher demand/delivery ratio (more demands/fewer deliveries) in a highly satisfied cataract PCS group compared with the nurse-sedated group [34]. This suggests that this metric may not be a useful measure of sedation adequacy; the mere act of pressing the button may be clinically significant.…”

Section: Clinical Experiencecontrasting

confidence: 64%

“…Ganapathy et al [31], in a study of elderly patients undergoing joint arthroplasty with regional AE propofol PCS, noted a tendency toward oversedation with PCS in older patients. In contrast, Yun et al [34] found enhanced patient satisfaction and no significant complication difference in the use of propofol PCS for cataract sedation in the elderly. This difference may be partly explained by the short duration and low dose regimen required for cataract surgery.…”

Section: Clinical Experiencementioning

confidence: 91%

“…Rudkin A number of groups have demonstrated applicability of PCS or PMS in a variety of ambulatory surgical procedures including: dental extraction [21,22] upper gastrointestinal endoscopy [23], shockwave lithotripsy [24,25], colonoscopy [17 , [26][27][28], endoscopic retrograde cholangiopancreatography [29], transvaginal oocyte retrieval [30], knee and hip arthroplasty [31], awake craniotomy [32], fiberoptic bronchoscopy [33], cataract surgery [34], dressing changes under anesthesia [35], minor emergency room surgical procedures [36]. The authors have experience with PCS for stapedectomy, prostate needle biopsy, and dilation & curettage.…”

Section: Clinical Experiencementioning

confidence: 99%

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Recent advances in patient-controlled sedation

Atkins

Mandel

2008

Current Opinion in Anaesthesiology

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Section: Clinical Experiencecontrasting

confidence: 64%

Section: Clinical Experiencementioning

confidence: 91%

Section: Clinical Experiencementioning

confidence: 99%

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Recent advances in patient-controlled sedation

Atkins

Mandel

2008

Current Opinion in Anaesthesiology

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“…But there are also a need for randomized studies of the optimal dose of propofol and its effect on safety and the need for interventions. With no lockout period, propofol doses of 3.33 mg, 21 and 4 mg, 22 has been used, and with a lock-out period of one minute doses of 10 mg, 23 17 mg 24 , and 20 mg 20 . Both strategies reported episodes of hypoxemia and required manipulation of the patients' airway to avoid serious events.…”

Section: Discussionmentioning

confidence: 99%

Alfentanil and patient‐controlled propofol sedation – facilitate gynaecological outpatient surgery with increased risk of respiratory events

Nilsson

Ustaal

et al. 2012

Acta Anaesthesiol Scand

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BackgroundWidespread use of patient‐controlled sedation (PCS) demands simplicity and a predictable outcome. We evaluated patients’ safety and ease of use of PCS for gynaecological outpatient procedures.MethodsIn a prospective double‐blind study, 165 patients were randomized to use propofol or propofol with alfentanil as PCS combined with local anaesthetic for pain control. Data on cardiopulmonary function, consciousness, and need for interventions were collected at baseline and every fifth minute. The surgeons’ evaluation of the ease and the duration of the procedure were recorded.ResultsOne hundred and fifty‐five patients used PCS for the entire procedure, 76 patients propofol, and 79 patients propofol/alfentanil. Fifteen procedures in the propofol group were limited or could not be done, compared with four in the propofol/alfentanil group (P = 0.02). The duration of surgery was not affected. The addition of alfentanil affected respiratory function compared with the propofol group: five patients compared with none were manually ventilated (P = 0.03), and two thirds, compared with a quarter, were given supplementary oxygen as their saturation decreased below 90% (P < 0.001). Overall cardiovascular stability was maintained. The propofol group had deeper conscious sedation as measured by the bispectral index (P = 0.03), but all patients could be roused. In the propofol/alfentanil group, five patients became apnoeic and could not be roused.ConclusionsPCS using propofol alone supports patients’ safety, as the addition of alfentanil increased the need for specific interventions to maintain respiratory stability. However, alfentanil increases the feasibility of the procedure, as complementary doses of propofol were not required.

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“…In one trial, patient-controlled sedation was administered in elective ophthalmologic day-surgery with a high level of patient satisfaction and no adverse effects on cognitive function [56], but the technique has not yet been validated in other studies. Perioperative sedation by dexmedetomidine infusion may be superior to other sedatives in reducing the incidence of POD [57,58], the effect on POCD is yet not elucidated.…”

Section: Anaesthetic Managementmentioning

confidence: 99%

Challenges in anaesthesia for elderly

Strøm

Rasmussen

2014

Singapore Dental Journal

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The segment of elderly individuals comprises a growing proportion of the global population. Health care systems and health care providers worldwide need to understand the specific challenges related to treatment of this heterogeneous patient population. The process of ageing is complex and under constant influence by numerous factors, for which reason the way human age is extremely individual. It is important to understand and acknowledge how elderly differ from younger adults, and how management needs to be modified and tailored to the individual patient in order to improve outcomes. The goal of treatment of an elderly patient is not necessarily to increase human longevity regardless of the consequences, but to increase active longevity free from disability and functional dependence. For older people, deterioration in function can be devastating and is often precipitated by a stressful event such as an acute episode of illness or injury. Therefore a mainstay of treatment of the aged is prevention of functional decline. In this review, we will outline the extreme variability in the aging process, and its implications for tailoring the perioperative care for the elderly. We will provide an overview of the challenges, when dealing with the aged surgical population with emphasis on postoperative cognitive changes.

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

Abstract: Both ACS and PCS using propofol provided reduced anxiety compared with control, but patient's satisfaction was higher in the PCS group compared with ACS group.

Cited by 16 publications

References 22 publications

Recent advances in patient-controlled sedation

Recent advances in patient-controlled sedation

Alfentanil and patient‐controlled propofol sedation – facilitate gynaecological outpatient surgery with increased risk of respiratory events

Challenges in anaesthesia for elderly

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