Universidad Autónoma del Estado de México, Toluca, Mexico.
Unidad de Investigación Médica en Enfermedades Metabólicas, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico.
Aging Clin Exp Res. 2018 Oct;30(10):1233-1239. doi: 10.1007/s40520-018-0914-0. Epub 2018 Feb 21.
A previous multidisciplinary pilot study based on computer simulations for the geriatric population showed that a dose of 0.5 mg/kg/h of propofol could sedate patients older than 65 for pacemaker implantation. The present study validates that the pacemaker implantation can be done in the elderly using 0.5-1 mg/kg/h of propofol with hemodynamic stability.
66 patients from 65 to 88 years old scheduled for pacemaker implantation were randomly assigned one of three doses of propofol. The first group received 2 mg/kg/h of propofol (P2) that is within normal range of the sedation dose. The second group received 1 mg/kg/h (P1) dose and the third group received the dose of 0.5 mg/kg/h (P0.5) according to the simulation-predicted dose for geriatric populations.
All patients kept MAP between 76 and 85 mmHg, with no hypotension episodes in any of the groups; therefore, they were all hemodynamically stable during the procedure. BIS was between 80 and 65 during the pacemaker implantation for the three groups, BIS of group P2 was significantly lower than the other groups. BIS in groups P1 and P0.5 was within the appropriated range for moderate sedation. Brice was positive for auditory recalls only when there was arousing noise in the operating room.
Moderate sedation, adequate for pacemaker implantation, can be achieved infusing 0.5-1 mg/kg/h of propofol in elderly patients when the patient has proper analgesia management at the device implantation site. The second important condition is to avoid unnecessary and alerting auditory and mechanical stimuli in the operating room, so that the patient will remain calm.
先前基于计算机模拟的老年患者多学科初步研究表明，丙泊酚 0.5mg/kg/h 剂量可镇静 65 岁以上患者进行起搏器植入。本研究验证了在老年人中使用丙泊酚 0.5-1mg/kg/h 剂量并保持血流动力学稳定的情况下可以进行起搏器植入。
66 名年龄在 65 至 88 岁之间的拟行起搏器植入术的患者被随机分配到三个丙泊酚剂量组之一。第一组接受 2mg/kg/h 的丙泊酚（P2），这是镇静剂量的正常范围。第二组接受 1mg/kg/h（P1）剂量，第三组根据模拟预测的老年人群剂量接受 0.5mg/kg/h（P0.5）剂量。
所有患者的平均动脉压（MAP）均保持在 76 至 85mmHg 之间，三组均无低血压发作；因此，在整个手术过程中，他们的血流动力学均保持稳定。三组患者在起搏器植入期间的 BIS 值均在 80 至 65 之间，P2 组的 BIS 值明显低于其他两组。P1 组和 P0.5 组的 BIS 值处于中度镇静的适当范围内。只有在手术室有唤醒噪音时，Brice 才对听觉回忆呈阳性。
在适当的镇痛管理下，老年患者可通过输注 0.5-1mg/kg/h 的丙泊酚来实现起搏器植入所需的适度镇静。第二个重要条件是避免手术室中不必要的和警醒的听觉和机械刺激，以使患者保持平静。
