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Premedication modifies the quality of sedation with propofol during regional anesthesia

Masashi Nakagawa, MD^*, Tadanori Mammoto, MD^*, Toshiko Sakai, MD^*, Yoshihiko Kishi, MD^* and Takashi Mashimo, MD

^* From the Departments of Anesthesiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, and
Osaka University Graduate School of Medicine, Osaka, Japan.

Address correspondence to: Dr. Masashi Nakagawa, Department of Anesthesiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Osaka City, 537-8511, Japan. Phone: 81-6-6972-1181; Fax: 81-6-6981-4060; E-mail: m.h.naka{at}f4.dion.ne.jp

Purpose: 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•kg^–1, 2.35 mg•kg^–1•hr^–1 and 2.89 mg•kg^–1•hr^–1, compared with 0.97 mg•kg^–1, 3.13 mg•kg^–1•hr^–1 and 3.59 mg•kg^–1•hr^–1 in Group-DZ, and 1.38 mg•kg^–1, 4.10 mg•kg^–1•hr^–1 and 4.36 mg•kg^–1•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.

Conclusion: 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.

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				D. Hohener, S. Blumenthal, and A. Borgeat Sedation and regional anaesthesia in the adult patient Br. J. Anaesth., January 1, 2008; 100(1): 8 - 16. [Abstract] [Full Text] [PDF]