title: Patient-controlled sedation in orthopedic surgery under regional anesthesia: a new approach in procedural sedation.
abstract: OBJECTIVE
  Regional anesthesia is a commonly used technique in orthopedic procedures. Sedation should reduce the patient's anxiety and fear while increasing regional anesthesia quality. This study evaluated the hemodynamic changes, level of sedation, both patients' and surgeons' levels of satisfaction and potential side effects in patient-controlled sedation using propofol.
  
  
  METHODS
  This randomized clinical trial studied sixty ASA physical class I-III patients scheduled for total knee replacement surgery under combined spinal-epidural anesthesia. Patients in Group P (n = 30) received propofol via a patient-controlled analgesia device with the following settings: intravenous propofol bolus dose 400 μg.kg(-1), 5-minute lockout interval and no basal infusion. In Group S, we infused saline 150 using the same settings. To determine the level of sedation, we used BIS and Observer's Assessment of Alertness/ Sedation Scale. For all patients, we recorded the number of requests. As the fi nal evaluation, we scored surgeons' and patients' satisfaction on 4-point scales.
  
  
  RESULTS
  Both BIS values and OAA/S scores were lower in Group P than in Group S. Patients' satisfaction was higher in Group P, although there was no significant difference with respect to surgeons' satisfaction between the groups. The number of requests for sedation was significantly higher in Group S. However, most requests were considered unsuccessful.
  
  
  CONCLUSIONS
  This study suggests that patient-controlled sedation with propofol can be used efficiently in orthopedic procedures.
authors.affiliation: Departamento de Anestesiologia, Special Genesis Hospital, Diyarbakir, Turquia.
authors.forename: Abdulselam
authors.initials: A
authors.lastname: Ekin
authors.forename: Ferah
authors.initials: F
authors.lastname: Donmez
authors.forename: Vildan
authors.initials: V
authors.lastname: Taspinar
authors.forename: Bayazit
authors.initials: B
authors.lastname: Dikmen
mesh_terms: D000368:Aged; D016058:Analgesia, Patient-Controlled; D000765:Anesthesia, Conduction; D016292:Procedural Sedation / Q000379:methods*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008875:Middle Aged; D019637:Orthopedic Procedures; D015742:Propofol / Q000008:administration & dosage*
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol
keywords: ANESTÉSICOS; Consciente; PCA Analgesia controlada pelo paciente; Regional; SEDAÇÃO; TÉCNICAS ANESTÉSICAS; TÉCNICAS DE ANALGESIA; Venoso; epidural; propofol; subaracnoidea