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Patient-Controlled Sedation and Analgesia with Propofol and Alfentanil: A Preliminary Safety Evaluation Prior to Use of Non-Anaesthesiology Doctors
Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Urology in Östergötland.
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2012 (English)In: Open Journal of Anesthesiology, ISSN 2164-5558, Vol. 2, no 2, 47-52 p.Article in journal (Refereed) Published
Abstract [en]

Background: The aim was to evaluate safety aspects of patient-controlled sedation and analgesia (PCS) for extracor-poreal shockwave lithotripsy (ESWL) and PCS to be handled by non-anaesthesiology doctors. Methods: Thirty-four ASA I-III patients used PCS with propofol and alfentanil for ESWL in this interventional study. Strict safety limits were defined regarding respiratory rate (RR), heart rate (HR), mean arterial blood pressure (MAP), oxygen saturation from pulse oximetry (SpO2), and transcutaneous partial pressures of oxygen (PtcO2) and carbon dioxide (PtcCO2). The pa-tients’ levels of consciousness was graded on a five-point scale and monitored with Bispectral Index (BIS). A nurse anaesthetist was supervising the procedure but was instructed to intervene only if safety limits were breached. No sup-plementary oxygen was given. Results: All patients responded to verbal stimuli during treatment. Cardiovascular sta-bility was maintained, but respiratory variables were affected. Two patients with SpO2 < 90% and two cases of RR ≤ 8 were diagnosed, and seven patients became hypercarbic (PtcCO2 ≥ 6.5 kPa). In 18 patients hypoxaemia was indicated as PtcO2 ≤ 8.0 kPa. All these 18 patients were given supplementary oxygen. There was no correlation between dose of drugs, age, weight or any vital variable. The 34 patients would use PCS again in the case of future treatment. Conclu-sions: During ESWL treatment PCS can be used with good patients’ satisfaction, and maintained cardiovascular stabil-ity, but PCS had an indisputable effect on pulmonary function with hypoxemia (resulting in need for supplementary oxygen) or hypercarbia. The person in charge of PCS must therefore be trained to perform according to the guidelines for sedation and/or analgesia by non-anaesthesiology doctors.

Place, publisher, year, edition, pages
Scientific Research Publishing, 2012. Vol. 2, no 2, 47-52 p.
Keyword [en]
Anaesthesia, Patient-Controlled Sedation, Safety, European Guidelines
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-99777DOI: 10.4236/ojanes.2012.22012OAI: oai:DiVA.org:liu-99777DiVA: diva2:658162
Available from: 2013-10-21 Created: 2013-10-21 Last updated: 2013-10-29Bibliographically approved

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Nilsson, AndreasSjöberg, FolkeLennmarken, Claes

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AnesthesiologyFaculty of Health SciencesDepartment of Anaesthesiology and Intensive Care in LinköpingBurn CenterDepartment of Hand and Plastic SurgeryDepartment of Urology in Östergötland
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