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Sedation with target-controlled propofol infusion during shoulder surgery under interscalene brachial plexus block in the sitting position: report of a series of 140 patients

Published online by Cambridge University Press:  13 October 2005

S. Vincent ,
D. Laurent  and
B. Francis
S. Vincent
Affiliation:
Clinique Générale, Department of Anaesthesiology, Annecy, France
D. Laurent
Affiliation:
Clinique Générale, Department of Anaesthesiology, Annecy, France
B. Francis
Affiliation:
Hôpital Tenon, Department of Anaesthesiology and Intensive Care, Paris, France
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Summary

Background and objective: The aim of this study was to assess target-controlled propofol infusion as a technique of sedation for shoulder surgery under interscalene brachial plexus block in the sitting position and to evaluate the effect of sedation on hypotensive/bradycardic events during this procedure. Methods: One hundred and forty patients undergoing elective shoulder surgery in the sitting position under interscalene brachial plexus block (with 30 mL of ropivacaine 0.75%) were prospectively enrolled. All patients were premedicated with hydroxyzine 1 mg kg−1, none received beta-blockers. No patients were given atropine except for the patients who experienced a vasovagal event either during the block procedure or intravenous catheter placement. The target-controlled propofol infusion was started immediately after positioning the patient on the operating table. The initial target concentration was 1 μg mL−1. The infusion rate was adjusted every 15 min by increasing or decreasing the target concentration by 0.2 μg mL−1 steps to maintain the patient rousable to verbal commands (score of 3 on Wilson sedation scale). The following parameters were assessed: minimal, maximal, optimal target concentration, respiratory and haemodynamic parameters, total propofol dose, additional alfentanil needs, occurrence of hypotensive/bradycardic events, complications. Results are mean ± SD. Statistical analysis used t-test and χ2-tests. Results: The optimal propofol target concentration was 0.8 μg mL−1. No respiratory complications or conversion to general anaesthesia was reported. Two patients experienced transient and inconsequential intraoperative agitation. The incidence of hypotensive/bradycardic events during the procedure was 5.7% (eight patients). Conclusion: Target-controlled propofol infusion (0.8–0.9 μg mL−1) following hydroxyzine premedication is a safe and effective technique for sedation when combined with interscalene brachial plexus block during shoulder surgery in the sitting position.

Keywords

ANAESTHESIA, INTRAVENOUS, target controlledPROPOFOLSURGICAL PROCEDURES OPERATIVE, shoulderANAESTHESIA CONDUCTION, nerve block, interscalene brachial plexus blockSYNCOPE, VASOVAGALHYPOTENSION
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 11 , November 2005 , pp. 853 - 857
Copyright
© 2005 European Society of Anaesthesiology

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