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| ORIGINAL ARTICLE |
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| 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
S Yaddanapudi, YK Batra, A Balagopal, NG Nagdeve
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
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0022-3859.33858
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 (13.0±4.2 vs. 18.8±4.2 min, P <0.001) and offset (8.9±2.8 vs. 12.5±3.5 min, P <0.001) of sedation were faster and the duration of adequate sedation longer (44.7±12.5 vs. 29.8±12.9% 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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