The role of patient-controlled apparatus for sedation in the emergency department.
OBJECTIVE
Hand trauma is a fairly common cause of emergency unit admissions. Various analgesic and sedative agents are used to decrease pain and anxiety during minor surgical procedures for hand trauma patients and provide more comfortable conditions for the surgeon. The aim of this study was to investigate the potential role of patient-controlled sedation (PCS) during surgical procedures done under local anesthesia for hand trauma in the emergency department.


METHODS
Forty ASA I-II (Assignment of the American Society of Anesthesiologists) patients who visited the emergency unit with hand trauma were randomized to 2 groups of 20 patients each. The control group received 1 microg/kg of fentanyl (i.v.) and 0.028 mg/kg of midazolam (i.v.). Additional 1 mg doses of midazolam were given by the anesthesiologist to keep the sedation level between 3 and 4. In the PCS group, the midazolam was administered after programming the apparatus. The settings were as follows: loading dose: 0.028 mg/kg, bolus dose 1 mg, lock-out period: 5 min and basal infusion rate: 0. The loading dose was given before local anesthesia. All patients received prilocaine hydrochloride (Citanest 2%, 10 mL) for local anesthesia. The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), oxygen saturation (SpO2) and respiration rate (RR) were measured before intervention and at 2, 3, 5, 10, 15, 20 and 30 minutes.


RESULTS
There were no differences in the demographic characteristics, operation and discharge times in the two groups (p>0.05). No cardiovascular or respiratory instability was observed in any patient, and SpO2 remained over 95% for all. The SBP, DBP, HR and SpO2 did not differ significantly (p>0.05). Although the sedation levels of all patients were satisfactory, the sedation levels of the control group were significantly lower at 5 and 15 minutes (p<0.05). The total midazolam dose was 4.3+1.1 in the control group and 4.0+0.8 in the PCS group. The patient satisfaction rate was 95% in the PCS group and 80% in the control group (p>0.05).


CONCLUSIONS
The two regimens did not differ with respect to hemodynamic changes, sedation levels and patient satisfaction. Therefore, PCS may be an acceptable alternative for surgical procedures performed using local anesthesia.
Kekeç
Zeynep
Z
Department of Emergency Medicine, Cukurova University Medical School, Adana, Turkey. zkekec@cu.edu.tr
Akin
Aynur
A
Kilinç
Sebnem
S
Sözüer
Erdoğan M
EM
D000328:Adult; D016292:Procedural Sedation / Q000379:methods*; D004636:Emergency Service, Hospital; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008874:Midazolam / Q000008:administration & dosage*; D010358:Patient Participation / Q000379:methods*; D017060:Patient Satisfaction; D011446:Prospective Studies
D006993:Hypnotics and Sedatives; D008874:Midazolam