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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2008 Marzo;74(3):57-62
Assisted sedation: a safe and easy method for pain-free percutaneous vertebroplasty
Della Puppa A. 1, Andreula C. 2, Frass M. 3
1 Anesthesiology Unit, Anthea Hospital, Bari, Italy;
2 Radiology Unit, Anthea Hospital, Bari, Italy;
3 Department of Internal Medicine I, Medical University Vienna, Vienna, Austria
Background. This study was performed to describe a method of assisted sedation for percutaneous vertebroplasty (PVP).
Methods. A non-randomized observational study was carried out on 20 patients ASA classes 2 and 3, who were undergoing PVP for vertebral body disruption. Patients, spontaneously breathing in prone position, were sedated using fentanyl and propofol. Sedation during PVP was maintained by continuous propofol infusion and was titrated to the patient’s need. In addition to sedation, 2% mepivacaine was used as a local anesthetic. Electrocardiogram (ECG) and oxygen saturation (SpO2) were continuously monitored. Blood pressure was checked every 5 min. The length of the procedure was recorded and the patient’s recovery from sedation was assessed according to a five-level scale, every 5 min from the end of the procedure. Time of discharge to the general ward was recorded. A four point (0-3) operator satisfaction score (OSS) was also used to evaluate surgeon’s satisfaction. This score was based on patient movements and procedure interruptions.
Results. Sedation allowed a pain free procedure, with high surgeon satisfaction and rapid recovery of the patient. Sedation decreased blood pressure and heart rate, but not SpO2; however, hypotension and bradycardia were not observed. Age was inversely correlated with propofol total dose. The mean total propofol dose was 4.5±1.4 mg/kg. The mean maintenance propofol dose rate was 5.7±1.4 mg/kg/h.
Conclusion. Assisted sedation is a safe and easy method for pain free PVP procedures. Age is an important factor to titrate propofol dose. However, it is noteworthy that no adverse effects were observed independent of age and physical status