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Balanced conscious sedation with intravenous induction and inhalational maintenance for patients requiring endoscopic and/or surgical procedures

Published online by Cambridge University Press:  08 August 2006

G. Y. Lahoud  and
P. M. Hopkins
G. Y. Lahoud
Affiliation:
University of Leeds, Academic Unit of Anaesthesia, St. James's University Hospital, Leeds, UK
P. M. Hopkins
Affiliation:
University of Leeds, Academic Unit of Anaesthesia, St. James's University Hospital, Leeds, UK
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Abstract

Summary

Background and objective: The use of inhalation sedation with sub-anaesthetic concentrations of sevoflurane and nitrous oxide mixture is expected to reduce amounts of intravenous sedative drugs needed to produce a balanced sedation with the benefits of having reduced side-effects. Methods: Eighty-two patients requiring endoscopic and/or surgical procedures under conscious sedation and local anaesthesia were recruited for this pilot study. Conscious sedation was induced with a titrated dose of midazolam and propofol given intravenously until the clinical end-point of conscious sedation was achieved. Subsequently, during the procedure, the patient was asked to breathe sevoflurane 0.1–0.3% and a fixed ratio of 40% nitrous oxide in oxygen given through a face mask. Results: In 78 patients (95.1%), the treatment was completed successfully. Patients were discharged back to the wards within 4–16 min (10.1) without significant side-effects. Treatment was satisfactorily accepted by 38 patients (48.7%) and considered excellent by 40 patients (51.3%). Conclusions: The use of titrated doses of intravenous sedative drugs for induction of conscious sedation followed by the use of low concentrations (0.1–0.3%) of sevoflurane combined with 40% nitrous oxide for maintenance of conscious sedation in patients requiring endoscopic and/or surgical procedures under local anaesthesia, has the potential advantages of reducing amounts of intravenous sedative drugs, less likelihood of problems from drug side-effects and fast recovery and discharge time. Further investigations to establish the technique are currently in progress.

Keywords

CONSCIOUS SEDATION, intravenous, inhalationANAESTHETICS INTRAVENOUS, midazolam, propofolANAESTHETICS INHALATION, sevoflurane, nitrous oxideENDOSCOPICAL PROCEDURESAMBULATORY SURGICAL PROCEDURESANAESTHESIA CONDUCTION
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 2 , February 2007 , pp. 116 - 121
Copyright
2007 European Society of Anaesthesiology

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