A Comparison Of Patient-Controlled Sedation Using Either Propofol Or Propofol-Remifentanil For Ophthalmic Operation

ObjectiveTo explore the advantage of patient-controlled sedation (PCS) with propofol and remifentanil in ophthalmic operation and to determine if remifentanil and propofol can provide adequate conditions for placement of a retrobulbar block prior to ophthalmic surgery.Methods1 .General materials42 ASA I or II patients undergoing elective ophthalmic surgery under a retrobulbar block were included in the study. Exclusion criteria included clinical evidence of heart failure,severe pulmonary disease,sedative medication within the previous month,difficulty with language or communication.2. GroupThe patients were randomly allocated to three groups:P group(1%propofol) (n=15),R group (0.5%propofol+0.001%remifentanil) (n=15) and control group(n=12) as placebo.Patients in PCS group had medications deliverd in LCP fashion by the automed AIPENG pump.Load dose was given 90 seconds before retrobular block. All patients were maintained with inhalation of oxygen 2L/min. 3.observationSBP,DBP,MAP,HR,SpO2,RR and AAI were monitored continuously together with intermittent asseement of sedation score.Baseline readings were recored and repeated at 5-min intervals thereafter. Dose of the medications and theduration of use of the sedation pump were recorded. Surgeon's satisfactory score, patient's cooperation score were measured at the end of surgery.The next day we inquired the patients if they were satisfied and if they had bad feelings.4.Statistical analysisChoose SPSS 11.0 software to analyse.Mean±standard express quantitative data, MAP,HR,SpO2, RR and AAI were compared using analysis of variance(ANOVA).P<0.05 were considered significant.ResultsThere were no significant differences in patient characteristics between the groups and no differences in duration of surgery(P>0.05).There was no clinically unacceptable changes in BP,HR, SpO2, AAI in all patients before surgery(P>0.05). 1. Comparision of the effect to the function of respiratory & circulation systems: The MAP was decreased in Group P compared with baseline(P<0. 05) .R group had a more frequent incidence of respiratory depression (P<0.05),especially its lower average respiratory rate.With inhalation of 2L/min oxygen,SpO2 was similar between three groups (P>0.05). 2. The values of AAI are lower in group P and group R than in group C during the early 45 min , but there are no diffence between the groups (P>0.05) .3. There was greater individual variation in terms of propofol and remifentanil consumption in PCS group. 4.Ramsay,cooperation and satisfactory score in group P and group R were higher than control group (P<0.05 ) , but there are no diffence between group P and group R (P>0.05 ) .5. Pain score during the placement of retrobular block are significant lower in group P and in group R than in group C,and there are also no diffence between group P and group R (P>0.05 ) .Conclusions1 .Sub-anaesthetic dose of propofol can provide adequate sedation, and when combiated with remifentanil,a new ultra-short acting opiate, more...