Premedication modifies the quality of sedation with propofol during regional anesthesia.
OBJECTIVE
To determine the effects of diazepam or clonidine on the quality of sedation with propofol during regional anesthesia.


METHODS
In a prospective randomised, controlled, double-blinded study, 60 patients undergoing elective gynecological surgery were studied. They were given premedication with 0.15-mg clonidine (Group-CL, n=20), 5-mg diazepam (Group-DZ, n = 20), or placebo (Group-P, n = 20) po. After spinal anesthesia was established, sedation was provided with propofol and controlled using a five-point sedation score at 3, "eyes closed but rousable to command", and 4, "eyes closed but rousable to mild physical stimulation". During sedation, blinded anesthesiologist recorded occurrence of complications. At two hours after end of sedation, patients were asked if they had intraoperative dream and memory.


RESULTS
The loading dose, steady-state infusion rate, and overall mean infusion rate in Group-CL were 0.80 mg x kg(-1), 2.35 mg x kg(-1) x hr(-1) and 2.89 mg x kg(-1) x hr(-1), compared with 0.97 mg x kg(-1), 3.13 mg x kg(-1) x hr(-1) and 3.59 mg x kg(-1) x hr(-1) in Group-DZ, and 1.38 mg x kg(-1), 4.10 mg x kg(-1) x hr(-1) and 4.36 mg x kg(-1) x hr(-1) in Group-P, respectively. Indices of both Group-CL (P < 0.001) and Group-DZ (P < 0.05) were smaller than those of Group-P Moreover, clonidine reduced the incidence of uncontrolled movement (P < 0.01), while diazepam reduced the incidence of intraoperative memory and increased the incidence of dream (P < 0.05). Premedication did not affect the incidence of other complications.


CONCLUSIONS
Both premedicants reduced propofol requirements and exerted beneficial effects on the incidence of some complications during sedation with propofol as an adjunct to regional anesthesia.
Nakagawa
M
M
Department of Anesthesiology, Osaka University Graduate School of Medicine, Osaka City, Japan. m.h.naka@f4.dion.ne.jp
Mammoto
T
T
Sakai
T
T
Kishi
Y
Y
Mashimo
T
T
D000328:Adult; D000368:Aged; D000765:Anesthesia, Conduction; D001364:Awareness; D001784:Blood Gas Analysis; D004311:Double-Blind Method; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D006993:Hypnotics and Sedatives; D007431:Intraoperative Complications / Q000453:epidemiology; D007813:Laparotomy; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011292:Premedication; D015742:Propofol; D012129:Respiratory Function Tests
D006993:Hypnotics and Sedatives; D015742:Propofol