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

• Published in: Journal of postgraduate medicine (Bombay) Vol. 53; no. 3; pp. 171 - 175
• Main Authors: Yaddanapudi, S, Batra, Y.K, Balagopal, A, Nagdeve, N.G
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India 01.07.2007; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd
• Subjects: Aged; Airway management; Anesthesia; Anesthesia, Spinal; Blood pressure; Comparative analysis; Conscious Sedation - economics; Conscious Sedation - methods; Costs; Drugs; Female; Humans; Hypnotics and Sedatives - administration & dosage; Hypnotics and Sedatives - adverse effects; Hypotension - chemically induced; Male; Medical research; Medicine, Experimental; Midazolam; Midazolam - administration & dosage; Midazolam - adverse effects; Middle Aged; Nausea; Nursing; Older people; patient age; Propofol; Propofol - administration & dosage; Propofol - adverse effects; regional; Sample size; sedation; Single-Blind Method; spinal; Standard deviation; Surgery; TURP; urological; India
• ISSN: 0022-3859; 0972-2823
• DOI: 10.4103/0022-3859.33858

Context : 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. Aims : 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. Settings and Design : A randomized single-blind study was conducted in 60 ASA I-II patients aged ≥60 years undergoing urological surgery under spinal anesthesia. Materials and Methods : 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′s Assessment of Alertness/Sedation Scale. Perioperative sedation, hemodynamics and respiratory events were monitored. Statistical Analysis : The analysis for parametric data was done using Student′s unpaired t test and the incidence data using Chi-square test. Results : The onset (13.0±4.2 vs. 18.8±4.2 min, P < 0.001) and offset (8.9±2.8 vs. 12.5±3.5 min, P < 0.001) of sedation were faster and the duration of adequate sedation longer (44.7±12.5 vs. 29.8±12.9% of total infusion time, P < 0.001) with propofol than midazolam. More patients receiving propofol compared to midazolam had hypotension (16 [50%] vs.4 [14.3%], P= 0.003). Airway obstruction occurred frequently in both the groups. Sedation was significantly more expensive with propofol than midazolam (US$ 9.83 ± 2.80 vs. US$ 0.33 ± 0.06, P 0.001). Conclusions : 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.