title: Variables Influencing the Depth of Conscious Sedation in Plastic Surgery: A Prospective Study.
abstract: BACKGROUND
  Conscious sedation has been widely utilized in plastic surgery. However, inadequate research has been published evaluating adequate drug dosage and depth of sedation. In clinical practice, sedation is often inadequate or accompanied by complications when sedatives are administered according to body weight alone. The purpose of this study was to identify variables influencing the depth of sedation during conscious sedation for plastic surgery.
  
  
  METHODS
  This prospective study evaluated 97 patients who underwent plastic surgical procedures under conscious sedation. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, and glucose levels were measured. Midazolam and ketamine were administered intravenously according to a preset protocol. Bispectral index (BIS) recordings were obtained to evaluate the depth of sedation 4, 10, 15, and 20 minutes after midazolam administration. Associations between variables and the BIS were assessed using multiple regression analysis.
  
  
  RESULTS
  Alcohol intake and female sex were positively associated with the mean BIS (P<0.01). Age was negatively associated with the mean BIS (P<0.01). Body mass index (P=0.263), creatinine clearance (P=0.832), smoking history (P=0.398), glucose (P=0.718), AST (P=0.729), and ALT (P=0.423) were not associated with the BIS.
  
  
  CONCLUSIONS
  Older patients tended to have a greater depth of sedation, whereas females and patients with greater alcohol intake had a shallower depth of sedation. Thus, precise dose adjustments of sedatives, accounting for not only weight but also age, sex, and alcohol consumption, are required to achieve safe, effective, and predictable conscious sedation.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital, Daegu, Korea.
authors.forename: Hyeonjung
authors.initials: H
authors.lastname: Yeo
authors.affiliation: Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital, Daegu, Korea.
authors.forename: Wonwoo
authors.initials: W
authors.lastname: Kim
authors.affiliation: Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital, Daegu, Korea.
authors.forename: Hyochun
authors.initials: H
authors.lastname: Park
authors.affiliation: Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital, Daegu, Korea.
authors.forename: Hoonnam
authors.initials: H
authors.lastname: Kim
keywords: Conscious sedation; Consciousness monitors; Deep sedation; Hypnotics and sedatives