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Comparison of A-Line Autoregressive Index and Observer Assessment of Alertness/Sedation Scale for Monitored Anesthesia Care With Target-controlled Infusion of Propofol in Patients Undergoing Percutaneous Vertebroplasty.
MedLine Citation:
PMID:  20706141     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Percutaneous vertebroplasty (PV) with monitored anesthesia care (MAC) is a growing trend. Without adequate sedation, patient movement can affect and even interrupt the procedure during MAC. The aim of this study was to compare the performance of the auditory-evoked potential (AEP) index and the Observer Assessment of Alertness/Sedation (OAA/S) scale as indicators of depth of sedation in patients undergoing PV.
METHODS: Two hundred and twenty patients in ASA II to III, aged 43 to 92 years, undergoing elective PV with MAC, were randomly allocated to the AEP or the OAA/S group (n=110 each). Initially, all patients received 1 μg/kg of fentanyl and 0.02 mg/kg of midazolam intravenously and sedation with a target-controlled infusion (TCI) of propofol at a target concentration of 1.2 μg/mL. The concentration for the propofol TCI was adjusted in 0.2 μg/mL increments or decrements according to the A-Line autoregressive index (AAI) or the OAA/S scale. A blinded study nurse recorded the measured parameters.
RESULTS: Some parameters were significantly different in the AEP group compared with the OAA/S group: lower AAI, lower OAA/S score, lower respiratory rates, and higher end-tidal carbon dioxide pressure were noted from local anesthetic infiltration to bone cement implantation, fewer patients whose movements affected the procedure (10 vs. 36, respectively, P<0.001), and more adjustments of TCI (twice vs. once, respectively, P<0.006). The surgeons' satisfaction was greater for the AEP group than for the OAA/S group.
CONCLUSIONS: TCI propofol with AEP monitoring can provide less patient movement, better sedation, and higher surgeon satisfaction in patients during prone-position PV procedures than can TCI propofol with OAA/S monitoring.
Authors:
Bo-Feng Lin; Yuan-Shiou Huang; Chang-Po Kuo; Da-Tong Ju; Chueng-He Lu; Chen-Hwan Cherng; Ching-Tang Wu
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgical anesthesiology     Volume:  23     ISSN:  1537-1921     ISO Abbreviation:  J Neurosurg Anesthesiol     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8910749     Medline TA:  J Neurosurg Anesthesiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  6-11     Citation Subset:  IM    
Affiliation:
Departments of *Anesthesiology †Neurosurgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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