Conscious sedation in Spinal Anaesthesia : A comparative study of Propofol versus Midazolam

Asjad Sharif, Ehtesham Haider Naqvi, Amanat Khan

Abstract


ABSTRACT 

 Objective:  To determine the advantages of conscious sedation in spinal anaesthesia by comparing Propofol with Midazolam.

  Methods: The Observational analytical study was conducted at Departments of Anaesthesia and Intensive Care, Combined Military Hospital, Rawalpindi from November 2014 to July 2015. The study include  60 patients undergoing various elective surgical procedures under spinal anaesthesia. The patients were divided into three groups of 20 patients each. Group a (n=20) received initial bolus of 30 mg of Propofol intravenously (IV) followed by 10 mg top ups on as required basis. Group b (n=20) received initial bolus of 2 mg of Midazolam followed by 1 mg increments to maintain the conscious sedation. Group c (n=20) did not receive any conscious sedation and was treated as a control group. The patients were interviewed through a structured questionnaire at the time of pre anaesthetic assessment and 24 hours after the surgical procedure. Demographic variables were scored using descriptive statistics and results were analyzed using correlation methods.

Results:  Iin patients who were given conscious sedation, 17 patients (85%) from Midazolam group as compared to 12 patients (60%) from Propofol group were not willing to have remained wide awake during the procedure. Similarly 15 patients (75%) from Midazolam group as compared to 10 patients (50%) from Propofol group were very much comfortable being asleep during the procedure. 10 patients (50%) from the group who were not given conscious sedation remained apprehensive and uncomfortable and they very much desired to be sedated during the procedure.

Conclusion:  Conscious sedation was very effective in spinal anaesthesia in alleviating preoperative anxiety and apprehension. Midazolam proved to be a better agent than Propofol for the purpose.

Key words: Conscious sedation, Spinal anaesthesia, Propofol, Midazolam.


References


REFERENCES

Neff J.A. Patient care guidelines for conscious sedation. Journal of emergency nursing 1992 ; 18 (2) :170 – 72.

Posner MI. Allention : The mechanism of consciousness. Proc Nat R Acad Sci USA 1994 ; 91 : 7398 – 7403.

Dubois A, Balatoni E, Peeters JP, Baudaux M. Use of Propofol for sedation during gastrointestinal endoscopies. Anaesthesia 1988 ; 43 : 875 – 80.

Ahmed A, Jafri W, Moid I, Humirary MT. Midazolam for day case upper GI endoscopy. J Coll Phys Surg Pakistan 1996 ; 6 (4) ; 199 – 200.

Mackenzie N. Sedation during regional anaesthesia : Indications, Advantages and Methods. Eur J Anaesthesiol suppl 1996 July ; 13 : 2 – 7 ; discussion 22 – 5.

Gudlin D J, Winch AE, Kochevar W. Ask the expert : conscious sedation J Soc Pediatr Nurs 1997 July – Sep ; 2 (3) : 143 – 7.

Holzman RS, Cullen DJ, Eichorn JH, Philip JH. Guidelines for sedation by non anaesthesiologists during diagnostic and therapeutic procedures. J Clin Anesth 1994 ; 6 ; 265 – 76.

Whitwam JG, McCloy RF. Techniques of conscious sedation. In : Whitwam JG, McCloy RF 2 Ed. Principles and practice of sedation, Oxford : Blackwell science, 1998 : 57.

Mussarat Afzal. Sedation in intensive care unit. J Anaesth and crit case 1996 ; 2 (4) : 33 – 38.

Cheng YJ, Wang YP, Fan SZ, LIU CC. Intravenous infusion of low dose Propofol for conscious sedation in caesarean section before spinal anaesthesia. Acta Anaesthesiol Sin 1997 Jun ; 35 (2) : 79 – 84.

Claffley L, Plourde G, Morris J, Trahan M, Dean DM, Sedation with Midazolam during regional anaesthesia : Is there a role for Flumazenil ? Can J Anaesth 1994 Nov ; 4 (11) : 1084 – 90.

Wappler F. Ladder concept of analgesia and sedation. In ; symposium : Midazolam – an established standard in conscious sedation, anaesthesiology and intensive care. 10th European Congress of Anaesthesiology Frankfurt, Germany ; 30 June – 4 July 1998.

Patterson KW, Casey PB, Murray JP, O’Boyle CA, Cunningham AJ. Propofol sedation for outpatient upper gastrointestinal endoscopy : Comparison with Midazolam. Br.J Anaesth 1991 July ; 67 (1) : 108 – 11.

Polster MR, Gray PA, Sullivan GO, McCarthy RA, Park GR. Comparison of the sedative and amnesic effects of Midazolam and Propofol. Br J Anaesth 1993 ; 70 : 612 – 16.

Ginsberg GG, Lewis JH, gallaghen JE. Diazepam versus Midazolam for Colonoscopy : a prospective evaluation of predicted versus actual dosing requirements. Gastro intest Endosc 1992 ; 38 : 651 – 56.

Rodrigo MR, Jonsson E. Conscious sedation with Propofol. Br Dent J 1989 Feb 11 : 166 (3) : 75 – 80.

De Andres J, Bolinches R. Comparative study of Propofol and Midazolam for sedation in regional anaesthesia. Rev Esp Anestesiol Reanim 1993 Nov – Dec ; 40 (6) : 354 – 9.

Crawford M, Pollock J, Anderson K. Comparison Of Midazolam with Propofol for sedation in outpatient bronchoscopy. Br J Anaesth 1993 ; 70 : 419 – 22.

Tung A, Rosenthal M. Patients requiring sedative. In critical care clinics 1995 ; 11 : 791 – 802.




KHYBER MEDICAL UNIVERSITY (KMU) PESHAWAR

KMU INSTITUTE OF MEDICAL SCIENCES (KIMS), KOHAT, KHYBER PAKHTUNKHWA, PAKISTAN- 2012

 

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