Yun M J, Oh A Y, Kim K O, Kim Y H
Department of Anaesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Sungnamsi, Kyonggido, Korea.
Int J Clin Pract. 2008 May;62(5):776-80. doi: 10.1111/j.1742-1241.2007.01544.x. Epub 2007 Dec 7.
Patient-controlled sedation (PCS) with propofol has been used successfully in various conditions, but controversies exist about its use in sedation of elderly patients for cataract surgery. This study evaluates the efficacy of anaesthetic nurse-controlled sedation (ACS) compared with PCS using the same device and the drug.
All of the 153 elderly patients (aged 51-88 years) undergoing cataract surgery with a sub-Tenon's infiltration were assigned to receive ACS (n = 51) or PCS (n = 51) with propofol or no intra-operative sedation (control, n = 51). Propofol was administered with a bolus dose of 10 mg and a lockout interval of 1 min. Cognitive function, sedation, pain, anxiety, side effects and satisfaction of patients were evaluated.
The mean +/- SD doses of propofol administered were 34.9 +/- 8.8 mg and 30.1 +/- 30.4 mg in the groups ACS and PCS, respectively. The anxiety score was lower in both ACS and PCS groups compared with control group but was not different between the two groups. Patient's satisfaction was highest in PCS group, ACS group was the next, compared with non-sedated group. Other parameters were not different among the three groups.
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.
丙泊酚患者自控镇静（PCS）已成功应用于各种情况，但在老年患者白内障手术镇静中的应用存在争议。本研究使用相同设备和药物，评估麻醉护士控制镇静（ACS）与PCS相比的疗效。
153例接受白内障手术并采用球后浸润麻醉的老年患者（年龄51 - 88岁）被分配接受丙泊酚ACS（n = 51）或PCS（n = 51），或术中不进行镇静（对照组，n = 51）。丙泊酚以10 mg的推注剂量和1分钟的锁定时间给药。评估患者的认知功能、镇静程度、疼痛、焦虑、副作用和满意度。
ACS组和PCS组丙泊酚的平均±标准差剂量分别为34.9±8.8 mg和30.1±30.4 mg。ACS组和PCS组的焦虑评分均低于对照组，但两组之间无差异。PCS组患者满意度最高，ACS组次之，非镇静组最低。三组间其他参数无差异。
与对照组相比，使用丙泊酚的ACS和PCS均能减轻焦虑，但PCS组患者满意度高于ACS组。
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