Intraoperative sedation for regional anesthesia in multiple trauma patients
DOI:
https://doi.org/10.15587/2313-8416.2015.38154Keywords:
intraoperative sedation, regional anesthesia, target control infusion (TCI) of propofol, DexmedetomidineAbstract
The aim of our study was to determine the role of sedation for surgery under regional anesthesia in multiple trauma patients, indications for intraoperative sedation, evaluation the efficacy and safety of different sedation methods.
Materials and methods. The study included 80 patients: 32 patients full consciousness regional anesthesia for surger and 48 patients - regional anesthesia with sedation. Depending on the method of sedation, patients were divided into groups: bolus Benzodiazepines / Barbiturates (Group 1), infusion of Propofol (Group 2), infusion of Propofol by target concentration (Group 3) and Dexmedetomidine infusion (Group 4). The analysis included Pearson correlation, analysis of variance - ANOVA, post-hoc test by Turk, frequency difference was assessed by bilateral Fisher criterion.
Results. Situational anxiety after surgery was the most significant correlation with intraoperative sedation (r=–0,55). The level of situational anxiety at the end of surgery and next morning was significantly different between groups: patients without sedation – 55,22±9,04 and 42,66±4,63 points to 46,02±4,91 and 38 19±5,31 points during the intraoperative sedation (p <0.001). The frequency of violations of ventilation and / adesaturatsiyi was highest among patients of group 1 – 75 % (p <0.001). Time target sedation: 51,67±5,94 % in Group 1, 60,25±6,57 % in 2 Group, 81,42±0,51 % and 81,17±5,77 % in Groups 3 and 4 respectively (p<0,001). Time to awaken the patient: 17,83±2,62 min and 14,75±2,18 min in Groups 1 and 2 vs. 8,83±2,72 min and 9,75±1,96 min in Groups 3 and 4 ( <0,001).
Conclusions. The use of regional techniques without sedation clinically significantly increases the level of situational anxiety in patients with multiple trauma. The best efficacy and safety profile observed during target control infusion (TCI) of propofol and Dexmedetomidine.
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