Hollmann Vivien C, Darwood Alastair R J, Sarai Pawandeep S, Strutton Paul H, Harrop-Griffiths William, Mullington Christopher J
Theatres and Anaesthetics, Imperial College Healthcare NHS Trust, London, UK; Anaesthetics Pain Medicine and Intensive Care (APMIC), Imperial College London, London, UK.
Theatres and Anaesthetics, Imperial College Healthcare NHS Trust, London, UK; Bioengineering, Imperial College London, London, UK.
Br J Anaesth. 2025 May;134(5):1341-1349. doi: 10.1016/j.bja.2025.01.034. Epub 2025 Mar 19.
Patient-controlled sedation has potential benefits, including rapid recovery and improved patient satisfaction. During patient-controlled sedation, the recipient presses a button to self-administer the sedative. The safety and efficacy of this method is dependent upon the dose relationships between the sedative's desired effects, its impact on the ability to press a button, and adverse effect occurrence. This study aimed to investigate the relationship between sedation, psychomotor function, and adverse effect occurrence during clinician-controlled sevoflurane sedation.
15 healthy participants (10 males) were administered a sevoflurane dose-escalation protocol starting at 0 kPa and increasing in 0.2 kPa increments until a protocol endpoint occurred. Sevoflurane was delivered using conventional anaesthetic apparatus. At each sevoflurane dose, Richmond Agitation-Sedation Scale (RASS) and psychomotor function were assessed. Protocol endpoints included airway, respiratory, or cardiovascular compromise; agitation (RASS ≥+2); and sedation >3 h.
The protocol endpoint was sedation >3 h for nine (60%) participants, agitation for five (33%) participants, and tonic movements for one (7%) participant. The median [range] sevoflurane dose was 0.4 [0.2-1.0] kPa when RASS <0 (sedation dose), 1.2 [0.6-2.0] kPa when participants were unable to complete reaction time testing (button-press dose), and 1.6 [1.2-2.2] kPa at the protocol endpoint (endpoint dose). The sedation dose was less than the button-press dose (P<0.0001), and the button-press dose was less than the endpoint dose (P=0.002).
Patient-controlled sevoflurane sedation is potentially feasible in a healthy population within the dose range 0.4-1.2 kPa. Concurrent reaction time monitoring could minimise the risk of agitation.
患者自控镇静具有潜在益处，包括快速恢复和提高患者满意度。在患者自控镇静过程中，接受者按下按钮自行给予镇静剂。该方法的安全性和有效性取决于镇静剂预期效果、对按按钮能力的影响以及不良反应发生之间的剂量关系。本研究旨在调查临床医生控制的七氟醚镇静过程中镇静、精神运动功能和不良反应发生之间的关系。
15名健康参与者（10名男性）接受七氟醚剂量递增方案，起始剂量为0 kPa，以0.2 kPa的增量递增，直至出现方案终点。使用传统麻醉设备输送七氟醚。在每个七氟醚剂量下，评估里士满躁动镇静量表（RASS）和精神运动功能。方案终点包括气道、呼吸或心血管功能受损；躁动（RASS≥+2）；以及镇静时间>3小时。
9名（60%）参与者的方案终点是镇静时间>3小时，5名（33%）参与者出现躁动，1名（7%）参与者出现强直运动。当RASS<0（镇静剂量）时，七氟醚剂量中位数[范围]为0.4[0.2 - 1.0]kPa，当参与者无法完成反应时间测试（按按钮剂量）时为1.2[0.6 - 2.0]kPa，在方案终点（终点剂量）时为1.6[1.2 - 2.2]kPa。镇静剂量低于按按钮剂量（P<0.0001），按按钮剂量低于终点剂量（P = 0.002）。
在健康人群中，0.4 - 1.2 kPa剂量范围内的患者自控七氟醚镇静可能是可行的。同时进行反应时间监测可将躁动风险降至最低。
