title: The safety of patient-controlled sedation.
abstract: We have investigated the safety of a previously described method of patient-controlled sedation in 100 healthy patients presenting for elective surgery. The device used 0.33-ml boluses of propofol (10 mg.ml-1) infused over 6 s with no lockout. All patients attempted to put themselves to sleep by pressing a button on the hand-held device. The oxygen saturation, heart rate, sedation score and airway patency were noted every minute. When the patient stopped pressing the button, the anaesthetist took over the handset and continued pressing the button until the patient became unresponsive. The system allowed rapid sedation. Only five patients were still anxious after 2 min. After 3 min, no patient was still anxious and more than 70 patients had slurred speech. When they stopped pressing the button, 11 patients were judged oversedated, of whom two were unresponsive. One patient's oxygen saturation decreased transiently to 84%: no other patient's oxygen saturation decreased below 90%. There were no other significant changes. We conclude that the system studied works well but carries too high a risk of oversedation for unsupervised use.
authors.affiliation: Department of Anaesthesia, Royal Oldham Hospital, Lancashire, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Thorpe
authors.forename: V R
authors.initials: VR
authors.lastname: Balakrishnan
authors.forename: L B
authors.initials: LB
authors.lastname: Cook
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D001835:Body Weight; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D015742:Propofol / Q000008:administration & dosage*; D011674:Pulse; D012646:Self Administration / Q000009:adverse effects; D012737:Sex Factors
chemical_list: D018686:Anesthetics, Intravenous; D010100:Oxygen; D015742:Propofol