Department of Anesthesiology, University of Utah, 30 N 1900 E, SOM 3C444, Salt Lake City, UT, 84132-2501, USA.
Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
J Clin Monit Comput. 2021 Apr;35(2):355-361. doi: 10.1007/s10877-020-00478-y. Epub 2020 Feb 6.
Audiovisual distraction (AVD) has been used to augment or replace procedural sedation. We investigated whether AVD in patients having total hip (THA) or total knee arthroplasty (TKA) under spinal anesthesia would reduce self-administered propofol consumption during surgery. 50 participants were randomized equally into a patient-controlled sedation (PCS) group or AVD group. All participants were given a spinal block and a propofol PCS device prior to surgery. In addition, Group AVD participants selected and watched a movie or documentary film on a tablet device with noise-cancelling headphones during surgery. The primary outcome of this study was total propofol consumption standardized as mcg/kg/min. Secondary outcomes evaluated increased supplemental oxygen use, rescue airway interventions, hypotension, disruptive movement events during surgery, sedation, and satisfaction with anesthesia scores. Historical clinician-controlled propofol usage at our institution over the previous 2 years were recorded. There was no significant difference in median propofol consumption between Groups PCS and AVD, 8.4 mcg/kg/min (1.6-18.9) vs 4 mcg/kg/min (0-9) (P = 0.29), respectively. Historical clinician-controlled usage of propofol demonstrated a median of 39.3 mcg/kg/min (29.2-51.2). There were few differences in the secondary outcome measures. The use of AVD did not reduce patient-controlled propofol consumption in patients having a THA or TKA surgery under spinal anesthesia.
视听分散（AVD）已被用于增强或替代程序镇静。我们研究了在接受脊髓麻醉下进行全髋关节置换术（THA）或全膝关节置换术（TKA）的患者中，AVD 是否会减少手术期间患者自行给予的异丙酚消耗量。50 名参与者被平均随机分为患者自控镇静（PCS）组或 AVD 组。所有参与者在手术前均接受脊髓阻滞和异丙酚 PCS 装置。此外，AVD 组的参与者在手术期间选择并在带有降噪耳机的平板电脑上观看电影或纪录片。本研究的主要结果是标准化为 mcg/kg/min 的总异丙酚消耗量。次要结果评估了增加的补充氧气使用、抢救气道干预、低血压、手术期间的干扰运动事件、镇静和麻醉评分的满意度。记录了我们机构过去 2 年中临床医生控制的异丙酚使用情况的历史数据。PCS 组和 AVD 组之间的中位异丙酚消耗没有显著差异，分别为 8.4 mcg/kg/min（1.6-18.9）和 4 mcg/kg/min（0-9）（P = 0.29）。异丙酚的历史临床医生控制使用中位数为 39.3 mcg/kg/min（29.2-51.2）。次要结果测量指标差异不大。在接受脊髓麻醉下进行 THA 或 TKA 手术的患者中，使用 AVD 并未减少患者自控异丙酚的消耗。
