Herrick I A, Gelb A W, Nichols B, Kirkby J
Department of Anaesthesia, University of Western Ontario, London Health Sciences Centre, University Campus, Canada.
Can J Anaesth. 1996 Oct;43(10):1014-8. doi: 10.1007/BF03011902.
Little information is available regarding the use of patient-controlled sedation (PCS) among elderly patients undergoing operative procedures under local or regional anaesthesia. This prospective, randomized study evaluated the safety of propofol PCS, and the attitude among elderly patients toward self-administration of sedation during cataract surgery.
Prospective, randomized study conducted in a University affiliated, tertiary-care hospital. Fifty-five elderly patients (aged 65-79 yr) were randomized to receive propofol patient-controlled sedation (PCS) (n = 28) or no intraoperative sedation (n = 27) during cataract surgery performed under peribulbar block. The PCS parameters consisted of a lockout interval of three minutes and a PCS dose of 0.3 mg.kg-1. Study groups were compared with respect to sedation, anxiety and discomfort visual analogue scores (VAS), cognitive functioning, patient satisfaction and the incidence of intraoperative complications.
Patients in the PCS group administered a mean propofol dose of 65 +/- 49 mg during procedures with a mean duration of 46 min. The incidence of intraoperative complications and sedation, anxiety and discomfort VAS were similar between groups. Patient satisfaction with PCS was high. In the PCS group, 10 (35%) of the 28 patients did not use the device because they were comfortable and did not feel they needed sedation. Satisfaction was higher in the PCS group (P = 0.02), whether or not they used the PCS device, compared with patients who did not receive a PCS device.
Propofol PCS represents a safe sedation technique among elderly patients in a monitored care setting. Elderly patients appear to prefer the option of receiving some form of intraoperative sedation and respond favourably to the opportunity to control administration.
关于局部或区域麻醉下接受手术的老年患者使用患者自控镇静（PCS）的信息较少。这项前瞻性随机研究评估了丙泊酚PCS的安全性，以及老年患者在白内障手术期间对自我给予镇静的态度。
在一家大学附属的三级护理医院进行前瞻性随机研究。55名老年患者（年龄65 - 79岁）被随机分为两组，在球周阻滞下进行白内障手术时，一组接受丙泊酚患者自控镇静（PCS）（n = 28），另一组不进行术中镇静（n = 27）。PCS参数包括3分钟的锁定间隔和0.3 mg·kg-1的PCS剂量。比较研究组在镇静、焦虑和不适视觉模拟评分（VAS）、认知功能、患者满意度以及术中并发症发生率方面的差异。
PCS组患者在平均持续46分钟的手术过程中平均给予丙泊酚剂量为65±49 mg。两组之间术中并发症发生率以及镇静、焦虑和不适VAS相似。患者对PCS的满意度较高。在PCS组中，28名患者中有10名（35%）未使用该设备，因为他们感觉舒适，不认为需要镇静。与未接受PCS设备的患者相比，PCS组患者的满意度更高（P = 0.02），无论他们是否使用了PCS设备。
在监测护理环境中，丙泊酚PCS是老年患者一种安全的镇静技术。老年患者似乎更喜欢接受某种形式的术中镇静，并对能够控制给药机会反应良好。
