Intra‐operative patient‐controlled sedation and patient attitude to control

Abstract

Intra‐operative patient controlled sedation with propofol (bolus dose 18 mg over 5.4 s; lockout period 1 min) has been compared 10 continuous propofol infusion (3.6 nig.kg −1 .h −1 ) in a randoniised crossover study of 38 ASA 1 or 2 day surgery patients mdergoing two‐stage bilateral extraction of third molar teeth under local anaesthesia (76 procedures). Mean (SD) propofol used (mg.kg −1 ) was less with patient‐controlled sedation (2.39 (1.28)) than with the infusion (2.58 (0.84)) but the difference was not statistically signifcant. There were only minor differences between the methods in postoperative recovery of cognitive tirnction and no differences for patient cooperation and surgeon's satisfaction with sedation. Patient‐controlled sedation was preferred by 19 patients, continuous infusion by 10, with nine indifferent. Preferences, expressed as mild, moderate or strong, were significantly stronger for patient‐controlled sedation (p < 0.05). Sedation was no deeper than eyelid closure with response ro command in all 76 procedures. This level was reached in all 38 infusion cases but in only 26 cases with patient‐controlled sedation, where 12 patients remained less sedated (p < 0.01). Patient‐controlled sedation with propofol provided safe sedation and was strongly preferred over the infusion by a large proportion of patients.