Ghimire A, Bhattarai B, Rahman T R, Singh S N, Koirala S, Tripathi M
Department of Anaesthesiology and Critical Care, BPKIHS, Dharan, Nepal.
Kathmandu Univ Med J (KUMJ). 2011 Jul-Sep;9(35):170-3. doi: 10.3126/kumj.v9i3.6299.
It is important to be able to measure and maintain a specific sedation level to compare outcomes of different levels of sedation during anesthesia and the aims include general patient comfort, freedom from specific discomfort, and some amnesia for both the block procedure and the surgical operation, in order to meet the patient preference and safety. In this prospective randomized clinical study, we compared the three different infusion doses of propofol.
To find out the appropriate infusion dose of propofol for optimal sedation without causing undue side effects in patients undergoing spinal anaesthesia.
One hundred twenty patients ASA PS I-II were randomly allocated to three groups 1, 2 and 3 receiving propofol infusion at the rate of 25, 50 and 75 microgram/kg/min with concentration of (0.5%), (1%) and (1.5%) respectively. They were observed for sedation score, hemodynamic parameters and satisfaction level. The adverse effects like respiratory depression, nausea and vomiting score were assessed.
Median sedation score increased in a dose dependent manner, with significantly higher scores in group 2 and 3 compared with group 1. Hemodynamic parameters were better in group 1 and 2 as judged by mephentermine requirement. The awakening time after stoppage of infusion was significantly delayed in group 3 (p < 0.001). Respiratory depression, nausea and vomiting were comparable clinically. Almost three fourth of the patients were satisfied with the techniques used.
Propofol infusion at the rate of 50 mcg/kg/min for sedation in spinal anaesthesia provides optimal sedation, early awakening and excellent satisfaction level in the postoperative period.
能够测量并维持特定的镇静水平对于比较麻醉期间不同镇静水平的效果很重要，其目的包括让患者总体舒适、免受特定不适以及对阻滞操作和外科手术有一定程度的遗忘，以满足患者的偏好和安全需求。在这项前瞻性随机临床研究中，我们比较了三种不同输注剂量的丙泊酚。
找出在脊髓麻醉患者中能提供最佳镇静效果且不引起过度副作用的丙泊酚合适输注剂量。
120例美国麻醉医师协会（ASA）分级为Ⅰ - Ⅱ级的患者被随机分为1、2、3组，分别接受丙泊酚输注，速率为25、50和75微克/千克/分钟，浓度分别为（0.5%）、（1%）和（1.5%）。观察患者的镇静评分、血流动力学参数和满意度水平。评估呼吸抑制、恶心和呕吐评分等不良反应。
中位镇静评分呈剂量依赖性增加，2组和3组的评分显著高于1组。根据去氧肾上腺素的需求判断，1组和2组的血流动力学参数较好。3组在输注停止后的苏醒时间显著延迟（p < 0.001）。呼吸抑制、恶心和呕吐在临床上相当。几乎四分之三的患者对所使用的技术感到满意。
脊髓麻醉中以50微克/千克/分钟的速率输注丙泊酚可提供最佳镇静效果、早期苏醒以及术后极佳的满意度。
