Alfentanil and patient-controlled propofol sedation - facilitate gynaecological outpatient surgery with increased risk of respiratory events.
Summary of "Alfentanil and patient-controlled propofol sedation - facilitate gynaecological outpatient surgery with increased risk of respiratory events."
BACKGROUND:
Widespread use of patient-controlled sedation (PCS) demands simplicity and a predictable outcome. We evaluated patients' safety and ease of use of PCS for gynaecological outpatient procedures.
METHODS:
In a prospective double-blind study, 165 patients were randomized to use propofol or propofol with alfentanil as PCS combined with local anaesthetic for pain control. Data on cardiopulmonary function, consciousness, and need for interventions were collected at baseline and every fifth minute. The surgeons' evaluation of the ease and the duration of the procedure were recorded.
RESULTS:
One hundred and fifty-five patients used PCS for the entire procedure, 76 patients propofol, and 79 patients propofol/alfentanil. Fifteen procedures in the propofol group were limited or could not be done, compared with four in the propofol/alfentanil group (P = 0.02). The duration of surgery was not affected. The addition of alfentanil affected respiratory function compared with the propofol group: five patients compared with none were manually ventilated (P = 0.03), and two thirds, compared with a quarter, were given supplementary oxygen as their saturation decreased below 90% (P < 0.001). Overall cardiovascular stability was maintained. The propofol group had deeper conscious sedation as measured by the bispectral index (P = 0.03), but all patients could be roused. In the propofol/alfentanil group, five patients became apnoeic and could not be roused.
CONCLUSIONS:
PCS using propofol alone supports patients' safety, as the addition of alfentanil increased the need for specific interventions to maintain respiratory stability. However, alfentanil increases the feasibility of the procedure, as complementary doses of propofol were not required.
Affiliation
Department of Anesthesiology and Intensive Care, Linköping University Hospital, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Journal Details
This article was published in the following journal.
Name: Acta anaesthesiologica Scandinavica
ISSN: 1399-6576
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22897508
- DOI: http://dx.doi.org/10.1111/j.1399-6576.2012.02749.x
Medical and Biotech [MESH] Definitions
Propofol
An intravenous anesthetic agent which has the advantage of a very rapid onset after infusion or bolus injection plus a very short recovery period of a couple of minutes. (From Smith and Reynard, Textbook of Pharmacology, 1992, 1st ed, p206). Propofol has been used as ANTICONVULSANTS and ANTIEMETICS.
Alfentanil
A short-acting opioid anesthetic and analgesic derivative of FENTANYL. It produces an early peak analgesic effect and fast recovery of consciousness. Alfentanil is effective as an anesthetic during surgery, for supplementation of analgesia during surgical procedures, and as an analgesic for critically ill patients.
Patient Positioning
Moving a patient into a specific position or POSTURE to facilitate examination, surgery, or for therapeutic purposes.
Outpatient Clinics, Hospital
Organized services in a hospital which provide medical care on an outpatient basis.
Electronic Health Records
Media that facilitate transportability of pertinent information concerning patient's illness across varied providers and geographic locations. Some versions include direct linkages to online consumer health information that is relevant to the health conditions and treatments related to a specific patient.
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