Sedation in patients above 60 years of age undergoing urological surgery under spinal anesthesia: Comparison of propofol and midazolam infusions

• Main Authors: Yaddanapudi S, Batra Y, Balagopal A, Nagdeve N
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2007-01-01
• Series: Journal of Postgraduate Medicine
• Subjects: Anesthesia; patient age; regional; sedation; spinal; surgery; TURP; urological
• Online Access: http://www.jpgmonline.com/article.asp?issn=0022-3859;year=2007;volume=53;issue=3;spage=171;epage=175;aulast=Yaddanapudi

<b>Context</b> : Propofol and midazolam are commonly used sedatives during regional anesthesia in adults. Smaller doses of these drugs are required in older age due to altered pharmacokinetics and pharmacodynamics. <b>Aims</b> : To study the sedation, side-effects and the costs involved with smaller doses of propofol and midazolam in patients aged above 60 years during spinal anesthesia. <b>Settings and Design</b> : A randomized single-blind study was conducted in 60 ASA I-II patients aged &#8805;60 years undergoing urological surgery under spinal anesthesia. <b> Materials and Methods</b> : Sedation was administered after spinal anesthesia using propofol (bolus 0.4 mg/kg^-1; infusion 3 mg/kg/hr) or midazolam (bolus 0.02 mg/kg; infusion 0.06 mg.kg^-1/h^-1 ) and titrated to achieve a sedation score of 3 on the modified Observer&#x2032;s Assessment of Alertness/Sedation Scale. Perioperative sedation, hemodynamics and respiratory events were monitored. <b> Statistical Analysis</b> : The analysis for parametric data was done using Student&#x2032;s unpaired t test and the incidence data using Chi-square test. <b>Results</b> : The onset (13.0&#x00B1;4.2 vs. 18.8&#x00B1;4.2 min, <i> P</i> &#60; 0.001) and offset (8.9&#x00B1;2.8 vs. 12.5&#x00B1;3.5 min, <i> P</i> &#60; 0.001) of sedation were faster and the duration of adequate sedation longer (44.7&#x00B1;12.5 vs. 29.8&#x00B1;12.9&#x0025; of total infusion time, <i> P</i> &#60; 0.001) with propofol than midazolam. More patients receiving propofol compared to midazolam had hypotension (16 [50&#x0025;] vs.4 [14.3&#x0025;], <i> P=</i> 0.003). Airway obstruction occurred frequently in both the groups. Sedation was significantly more expensive with propofol than midazolam (US$ 9.83 &#x00B1; 2.80 vs. US$ 0.33 &#x00B1; 0.06, <i> P<</i> 0.001). <b>Conclusions</b> : Propofol provided better titration and adequacy of sedation than midazolam in patients above 60 years of age, but caused hypotension. Lighter sedation is recommended in this age group.