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 ORIGINAL ARTICLE
Year : 2007  |  Volume : 53  |  Issue : 3  |  Page : 171-175

Sedation in patients above 60 years of age undergoing urological surgery under spinal anesthesia: Comparison of propofol and midazolam infusions


Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
S Yaddanapudi
Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0022-3859.33858

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Context : Propofol and midazolam are commonly used sedatives during regional anesthesia in adults. Smaller doses of these drugs are required in older age due to altered pharmacokinetics and pharmacodynamics. Aims : To study the sedation, side-effects and the costs involved with smaller doses of propofol and midazolam in patients aged above 60 years during spinal anesthesia. Settings and Design : A randomized single-blind study was conducted in 60 ASA I-II patients aged ≥60 years undergoing urological surgery under spinal anesthesia. Materials and Methods : Sedation was administered after spinal anesthesia using propofol (bolus 0.4 mg/kg-1; infusion 3 mg/kg/hr) or midazolam (bolus 0.02 mg/kg; infusion 0.06 mg.kg-1/h-1 ) and titrated to achieve a sedation score of 3 on the modified Observer's Assessment of Alertness/Sedation Scale. Perioperative sedation, hemodynamics and respiratory events were monitored. Statistical Analysis : The analysis for parametric data was done using Student's unpaired t test and the incidence data using Chi-square test. Results : The onset (13.04.2 vs. 18.84.2 min, P <0.001) and offset (8.92.8 vs. 12.53.5 min, P <0.001) of sedation were faster and the duration of adequate sedation longer (44.712.5 vs. 29.812.9% of total infusion time, P <0.001) with propofol than midazolam. More patients receiving propofol compared to midazolam had hypotension (16 [50%] vs.4 [14.3%], P= 0.003). Airway obstruction occurred frequently in both the groups. Sedation was significantly more expensive with propofol than midazolam (US$ 9.83 2.80 vs. US$ 0.33 0.06, P< 0.001). Conclusions : Propofol provided better titration and adequacy of sedation than midazolam in patients above 60 years of age, but caused hypotension. Lighter sedation is recommended in this age group.






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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow