Propofol, Fentanyl Target Controlled Infusion Sedation Analgesia Clinical Research

Background and Objectives Procedural Sedation Analgesia (PSA), widely used as a practical anesthesia technology, plays an important role in patients undergoing ambulatory or short time surgery. However, as the traditional PSA is primarily given by repeated doses or continuous infusion, it is a challenge for anesthesiologists to offer the appropriate depth of anesthesia that is needed. Consequently, the process of providing a steady, comfortable, and maneuverable anesthesia is becoming an important subject in clinical anesthesia.Target controlled infusion (TCI), which is controlled by a microcomputer, is a new medication delivery technique. There are some mature applications of target controlled infusion of propofol and remifentanil in general anesthesia, but little information in PSA. The purpose of this study is to compare the clinical effects between TCI and continuous infusion of propofol and remifentanil.Methods Sixty patients scheduled for plastic surgery with local anesthesia, ASA Ⅰ～Ⅱ, were randomly assigned to two groups:TCI group(group T), and continuous infusion group(group C). OAA/S was used to observe the sedation and analgesia effects of the two groups. In addition, HR, MAP, RR, SpO2, were recorded at the following time points: before administration(TO),3min after given propofol(T1),3min after increasing remifentanil(T2), local anesthesia(T3), skin incision(T4),10min (T5),30min(T6), and60min(T7) after skin incision, operation finished(T8),3min after cease of infusion(T9), discharge(T10).We also recorded the incidence of hyoxemia, bradypnea and/or apnea during the operation, and also the quantity of anesthetic. The memories during operation, postoperative pain, postoperative nausea and vomit, and patient satisfaction scores were followed up after operation.Results Patients of both two groups received satisfactory sedation and analgesia, and the modified OAA/S scales were approximately2～3points. The dosage of propofol was about365mg in group T and about402mg in group C(P<0.05), on the other hand, the dosage of remifentanil was about331μg in group T and about379μg in group C(P<0.05). The incidence of hyoxemia was23.3%in group T and50.0%in group C respectively(P<0.05), the incidence of bradypnea and/or apnea was higher in group C than that in groups T simultaneously(P<0.05). The satisfaction of patients was higher in group T than that in group C, however, the incidence of postoperative complications did not show differences.Conclusion1. Both TCI and continuous infusion of propofol and remifentanil are able to provide patients with satisfactory effects of PSA, with significant better effects in TCI group.2. Target controlled infusion can decrease the dosage of both propofol and remifentanil.3. Although the incidence of respiratory depression was high when combination approach of propofol and remifentanil was used in PSA, it can be effectively reduced by using a target controlled infusion technique.