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Balanced conscious sedation with intravenous induction and inhalational maintenance for patients requiring endoscopic and/or surgical procedures

Published online by Cambridge University Press:  08 August 2006

G. Y. Lahoud  and
P. M. Hopkins
G. Y. Lahoud
Affiliation:
University of Leeds, Academic Unit of Anaesthesia, St. James's University Hospital, Leeds, UK
P. M. Hopkins
Affiliation:
University of Leeds, Academic Unit of Anaesthesia, St. James's University Hospital, Leeds, UK
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Abstract

Summary

Background and objective: The use of inhalation sedation with sub-anaesthetic concentrations of sevoflurane and nitrous oxide mixture is expected to reduce amounts of intravenous sedative drugs needed to produce a balanced sedation with the benefits of having reduced side-effects. Methods: Eighty-two patients requiring endoscopic and/or surgical procedures under conscious sedation and local anaesthesia were recruited for this pilot study. Conscious sedation was induced with a titrated dose of midazolam and propofol given intravenously until the clinical end-point of conscious sedation was achieved. Subsequently, during the procedure, the patient was asked to breathe sevoflurane 0.1–0.3% and a fixed ratio of 40% nitrous oxide in oxygen given through a face mask. Results: In 78 patients (95.1%), the treatment was completed successfully. Patients were discharged back to the wards within 4–16 min (10.1) without significant side-effects. Treatment was satisfactorily accepted by 38 patients (48.7%) and considered excellent by 40 patients (51.3%). Conclusions: The use of titrated doses of intravenous sedative drugs for induction of conscious sedation followed by the use of low concentrations (0.1–0.3%) of sevoflurane combined with 40% nitrous oxide for maintenance of conscious sedation in patients requiring endoscopic and/or surgical procedures under local anaesthesia, has the potential advantages of reducing amounts of intravenous sedative drugs, less likelihood of problems from drug side-effects and fast recovery and discharge time. Further investigations to establish the technique are currently in progress.

Keywords

CONSCIOUS SEDATION, intravenous, inhalationANAESTHETICS INTRAVENOUS, midazolam, propofolANAESTHETICS INHALATION, sevoflurane, nitrous oxideENDOSCOPICAL PROCEDURESAMBULATORY SURGICAL PROCEDURESANAESTHESIA CONDUCTION
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 2 , February 2007 , pp. 116 - 121
Copyright
2007 European Society of Anaesthesiology

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References

Coulthard P, Craig D. Conscious sedation. Dent Update 1997; 24: 376–381.Google Scholar
The Association of Anaesthetists of Great Britain and Ireland; Recommendation for standards of monitoring during anaesthesia and recovery.The Association of Anaesthetists of Great Britain and Ireland, 3rd edn, Revised, December 2000.
The Royal College of Anaesthetists; Report of an Intercollegiate Working Party.Implementing and Ensuring Safe Sedation Practice for Healthcare Procedures in Adults. November 2001.
The National Confidential Enquiry into Patient Outcome and Death.The 2000 Report of the National Confidential Enquiry into Perioperative Deaths. November 2000.
Cote CJ, Karl HW, Notterman DA, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: analysis of medications used for sedation. Pediatrics 2000; 106(4): 633–644.Google Scholar
Malviya S, Voepel-Lewis T, Prochaska G, Tait AR. Prolonged recovery and delayed side effects of sedation for diagnostic imaging studies in children. Pediatrics 2000; 105(3): E42.Google Scholar
Hansen TG. Propofol infusion syndrome in children. Ugeskr Laeger 2005; 167(39): 3672–3675.Google Scholar
Roback MG, Wathen JE, Bajaj L, Bothner JP. Adverse events associated with procedural sedation and analgesia in a pediatric emergency department: a comparison of common parenteral drugs. Acad Emerg Med 2005; 12(6): 508–513.Google Scholar
Patel S, Vargo JJ, Khandwala F, Lopez R, Trolli P, Dumot JA, Conwell DL, Zuccaro G. Deep sedation occurs frequently during elective endoscopy with meperidine and midazolam. Am J Gastroenterol 2005; 100(12): 2689–2695.Google Scholar
Lahoud GYG, Averley PA, Hanlon MR. Sevoflurane inhalation conscious sedation for children having dental treatment. Anaesthesia 2001; 56: 476–480.Google Scholar
Lahoud GYG, Averley PA. Comparison of sevoflurane and nitrous oxide mixture with nitrous oxide alone for inhalation conscious sedation in children having dental treatment: a randomised controlled trial. Anaesthesia 2002; 57: 446–450.Google Scholar
Mason KP, Zurakowski D, Karian VE, Connor L, Fontain PJ, Burrows PE. Sedatives used in paediatric imaging: comparison of IV pentobarbital with IV pentobarbital with midazolam added. AJR Am J Roentgenol 2001; 177: 427–430.Google Scholar
Runes J, Strom C. Midazolam intravenous conscious sedation in oral surgery, a retrospective study of 372 cases. Swed Dent J 1996; 20: 29–33.Google Scholar
Campbell RL, Ross GA, Campbell JR, Mourino AP. Comparison of oral chloral hydrate with intramuscular ketamine, meperidine, and promethazine for pediatric sedation – preliminary report. Anesth Prog 1998; 45: 46–50.Google Scholar
Agostino J, Terndrup TE. Chloral hydrate versus midazolam for sedation of children for neuroimaging: a randomized clinical trial. Pediatr Emerg Care 2000; 16: 1–4.Google Scholar
Winn CW, Porter AG, Vincent RN. Oral meperidine, atropine, and pentobarbital for pediatric conscious sedation. Pediatr Nurs 2000; 26: 500–502, 509.Google Scholar
Dallman JA, Ignelzi JrMA, Briskie DM. Comparing the safety, efficacy and recovery of intranasal midazolam vs. oral chloral hydrate and promethazine. Pediatr Dent 2001; 23: 424–430.Google Scholar
Manuli MA, Davies L. Rectal methohexital for sedation of children during imaging procedures. Am J Roentgenol 1993; 160: 577–580.Google Scholar
Otley CC, Nguyen TH. Conscious sedation of pediatric patients with combination oral benzodiazepines and inhaled nitrous oxide. Dermatol Surg 2000; 26: 1041–1044.Google Scholar
Wilson KE, Welbury RR, Girdler NM. A randomized, controlled, crossover trial of oral midazolam and nitrous oxide for paediatric dental sedation. Anaesthesia 2002; 57: 860–867.Google Scholar
Jackson DL, Johnson BS. Inhalational and enteral conscious sedation for the adult patient. Dent Clin North Am 2002; 46: 781–802.Google Scholar
Girdler NM, Rynn D, Lyne JP, Wilson KE. Patient controlled propofol sedation in phobic patients. Anaesthesia 2000; 55: 327–333.Google Scholar
Cook LB, Lockwood DG, Moore CM, Whitwam JG. True patient controlled sedation. Anaesthesia 1993; 48: 1039–1044.Google Scholar
General Dental Council.Maintaining Standards: Guidance to Dentists on Professional and Personal Conduct.London: General Dental Council, November 1998 and May 1999.
Department of Health.A Conscious Decision. A Review of the Use of General Anaesthesia and Sedation in Primary Dental Care.London: Department of Health, 2000.