Propofol or midazolam for sedation during spinal anaesthesia with 0.5% bupivacaine in elderly orthopedic patients

Abstract

Study objective. To compare the efficacy of sedation with midazolam and propofol in elderly patients submitted to orthopedic interventions under spinal anaesthesia with 1.5 ml 0.5% bupivacaine.

Material and methods. 40 patients, aged 65 to 96 years, operated under spinal anaesthesia for lower limb traumatic surgery were randomly allocated into two equal groups: group 1, sedated with an i.v. infusion of 0.2 mg/kg/h of midazolam and group 2, sedated with 2.6 mg/kg/h propofol. Infusion doses were adjusted to maintain a level of sedation 4 on the Ramsay scale. The following parameters were monitored: the mean time to reach the required level of sedation and the mean time for recovery; heart rate, blood pressure and respiration (SpO2) during sedation; incidence of postoperative delirium and other side-effects; patients’ satisfaction.

Results. The mean time to reach the required level of sedation was similar in both groups. Recovery, as judged by the ability to open eyes and recall date of birth was significantly more rapid after sedation with propofol. Amnesia was greater after midazolam. Both drugs decreased blood pressure but not more than 20% of initial values. The respiration was stable and no patient developed delirium postoperatively. There were no intergroup differences regarding the overall satisfaction.

Conclusion. Both propofol and midazolam by i.v. infusion provide a satisfactory sedation in elderly orthopedic patients operated under spinal anaesthesia. Recovery was significantly faster after sedation with propofol, while sedation with midazolam was followed by a period of amnesia.

Key words: propofol, midazolam, sedation, spinal anaesthesia, lower limb trauma surgery, elderly

Propofol sau midazolam pentru sedarea bolnavului vârstnic, supus intervenţiilor chirurgicale ortopedice pe membrul inferior, sub rahianestezie cu bupivacaină izobară 0,5%

Jurnalul Român de Anestezie Terapie intensivă 2006 Vol.13 Nr.2, 97-102