A comparative analysis of 3 sedation guidelines for patients undergoing subarachnoid anesthesia. Randomized, single blind clinical trial
Abstract
Introduction: Sedation is defined as the set of actions aimed at having a quiet, comfortable, pain-free patient during a diagnostic or therapeutic procedure without any bad memories. Since the standard regional anesthesia techniques used in clinical practice are relatively traumatic and painful procedures, sedation has been introduced to make these interventions more comfortable for the patient and to facilitate the patient's cooperation.
Objective: To establish the efficacy of three sedation guidelines in patients undergoing sub-arachnoid anesthesia.
Methodology: Experimental, randomized, prospective, single blind clinical trial comparing three guidelines for the sedation of patients undergoing subarachnoid anesthesia.
Results: All of the patients in the trial received anxiolysis, collaborated with the puncture and said that they would not be afraid to receive subarachnoid anesthesia in the future. There were no complications including respiratory depression, nausea, vomiting or any other complications reported with the use of the sedation guidelines. Patient satisfaction was high. Withdrawal reflex (P = 0.0003) and puncture related pain (P = 0.0069) were more common in the group using the intravenous midazolam-only guideline and patient satisfaction with sedation was also lower in this group; however, the three guidelines showed good efficacy.
Conclusions: The three sedation guidelines presented were effectively used in subarachnoid anesthesia; the results were more favorable with the use of midazolam + fentanyl or midazolam + ketamine.
References
2. Gomar C, Sabaté S, Mayoral V, Canet J, Alcón A, Aliaga L. Distribución de la actividad, tipos de anestesia y recursos humanos en Cataluña en 2003. Med Clin (Barc). 2006;126:19-26.
3. Sutcliffe N. Sedation during loco-regional anaesthesia. Acta Anaesthesiol Belg. 2000;51:153-6.
4. Nishiyama T, Yokoyama T, Hanaoka K. Sedation guidelines for midazolam infusion during combined spinal and epidural anesthesia. J Clin Anesth. 2004;16:568-72.
5. Rama-Maceiras P, Gomar C, Criado A, Arízaga A, Rodríguez A, Marenco M. Sedación para procedimientos quirúrgicos realizados con anestesia regional en pacientes adultos. Resultados de una encuesta entre anestesiólogos españoles. Rev Esp Anestesiol Reanim. 2008;55:217-26.
6. Torres A, Villalba J. Midazolam-fentanyl, conveniencia para sedación en cirugía oftálmica. Ensayo clínico. Rev Colomb Anestesiol. 2005;33:245-9.
7. Kunisawa T. Dexmedetomidine was safely used for sedation during spinal anesthesia in a very elderly patient. J Anesth. 2010;24:938-41.
8. Myron Y, Bean J. Pain, sedation and postoperative anesthetic management in the Pediatric Intensive Care Unit. In: Rogers MC, editor. Textbook of pediatric intensive care. 3ª. ed. Baltimore: Williams and Wilkins; 1996;1548-93.
9. Mato M, Pérez A, Otero J, Torres LM. Dexmedetomidina, un fármaco prometedor. Rev Esp Anestesiol Reanim. 2002;49:407-20.
10. Martínez E. Aplicaciones prácticas: Sedación en Anestesia Regional [Accessed 1 April 2011]. Available from: http://www.tivabcn.org/2006/capitol07.pdf.
11. Sutcliffe N, Amutike D. Patient controlled sedation during locoregional anaesthesia. In: Jaap V, Frank E, Sandra G-M, editors. On the study and practice of intravenous anaesthesia. Glasgow, UK: Kluwer Academic Publishers; 2000;129-44.
12. Contreras V, Carbonell P, Ojeda A, Sanzana E. Fentanilo intradural disminuye los requerimientos de propofol utilizado para sedación durante la anestesia espinal. Rev Esp Anestesiol Reanim. 2007;54:421-4.
13. Kim D. Dreaming in sedation during spinal anesthesia: a comparison of propofol and midazolam infusion. Anesth Analg. 2011;112:1076-81.
14. Linares M. Aplicaciones prácticas: Sedaciones monitorizadas [Accessed 1 April 2011]. Available from: http://www.sld.cu/galerias/pdf/sitios/anestesiologia/capitol06.pdf.
15. Höhener D, Blumenthal S, Borgeat A. Sedation and regional anaesthesia in the adult patient. Br J Anaesth. 2008;100: 8-16.
16. What is a Random Variable? [Accessed 1 April 2011]. Available from: http://www.stattrek.com/statistics/random-numbergenerat
or.aspx.
17. Villeret I, Laffon M, Ferrandiere M, Delerue D, Fusciardi J. Which propofol target concentration for ASA III elderly patients for conscious sedation combined with regional anaesthesia? Ann Fr Anesth Reanim. 2003;22: 196-201.
18. Paqueron X, Lumbroso A, Mergon Pi, Aubrun F, Langeron O, Coriat P, et al. ¿Es la sedación sinónimo de analgesia durante la administración de morfina intravenosa? Br J Anaesth. 2002;89:697-701.
19. Ramsay M, Savege T, Simpson B, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974;2:656-9.
20. Celis E, Besso J, Birchenall C, De la Cal M, Carrillo R, Castorena G, et al. Guía de práctica clínica basada en la evidencia para el manejo de la sedo-analgesia en el paciente adulto críticamente enfermo. Med Intensiva. 2007;31:428-71.
21. [Accessed 1 April 2011]. Available from: http://www.ict.edu.mx/acervo_bibliotecologia_escalas_Escala%20de%20Likert.pdf.
22. Cullen D, Apolone G, Greenfield S, Guadagnoli E, Cleary P. ASA physical status and age predict morbidity after three surgical procedures. Ann Surg. 1994;220:3-9.
24. ASA classification system [Accessed 1 April 2011]. Available from: http://www.sld.cu/galerias/pdf/sitios/rehabilitacion/sistema_de_clasificacion_asa.pdf.
25. Savoia G, Loreto M, Gravino E, Canfora A, Frangiosa A, Cortesano P, et al. Monitored anesthesia care and locoregional anesthesia. Vascular surgery use. Minerva Anestesiol. 2005;71:539-42.
26. Reves J, Glass P, Lubarsky D, McEvoy M, Martinez R. In: Miller R, Eriksson L, Fleisher L, Wiener-Kronish J, Young W, editors. Miller's anesthesia. 7th ed. Philadelphia, PA: Churchill Livingstone; 2010;719-68.
27. Vanegas A. Dosificaciones en anestesia intravenosa total. In: Vanegas A, editor. Anestesia intravenosa. 2 ed. Bogotá, Colombia: Editorial medica panamericana; 2008;422-72.
28. Whizar V. Anestesia para Cirugía Facial Cosmética [Accessed 1 April 2011]. Available from: http://www.anestesiadolor.org/anestesia/docs/Anestesia%20para%20cirugiaFacial%20Cosmetica.htm.
29. Concha A, Rey C, Suárez S. Sedación y analgesia en el politraumatismo pediátrico. Bol Pediatr. 2009;49:69-77.
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