STUDY OBJECTIVE: To test the hypothesis that sedation in elderly patients is often electrophysiologically equivalent to general anesthesia (GA). DESIGN: Prospective, observational study. SETTING: Operating room of a university medical center. PATIENTS: 40 elderly patients (>or=65 yrs of age) undergoing hip fracture repair with spinal anesthesia and propofol-based sedation. INTERVENTIONS: In the routine practice group (RP; n = 15), propofol sedation was administered per the usual routine of the anesthesiologist. In the targeted sedation group (TS; n = 25), sedation was titrated to an observer's assessment of alertness/sedation (OAA/S) score of 4 (ie, lethargic in response to name called) to 5 (ie, awake and alert). MEASUREMENTS: Both patient groups underwent processed electroencephalographic monitoring using bispectral index (BIS) intraoperatively. BIS levels were compared between groups to determine amount of surgical time spent in GA (BIS <or= 60). MAIN RESULTS: In the RP group, subjects spent 32.2% of surgical time at BIS levels consistent with GA. Although averaged BIS values during surgery increased from (mean +/- SD) 71 +/- 16 to 88 +/- 9 (P < 0.001), GA was still observed during 5% of surgical time in the TS group. Overall, 13 of 15 (87%) RP group patients and 11 of 25 (44%) TS group patients (P < 0.010) experienced some period of GA. CONCLUSIONS: BIS levels consistent with GA occur frequently in elderly patients during propofol-based sedation for spinal anesthesia. Altering routine practice such that sedation is titrated to a targeted clinically-determined sedation level reduces - but does not eliminate - this incidence. (c) 2010 Elsevier Inc. All rights reserved.
STUDY OBJECTIVE: To test the hypothesis that sedation in elderly patients is often electrophysiologically equivalent to general anesthesia (GA). DESIGN: Prospective, observational study. SETTING: Operating room of a university medical center. PATIENTS: 40 elderly patients (>or=65 yrs of age) undergoing hip fracture repair with spinal anesthesia and propofol-based sedation. INTERVENTIONS: In the routine practice group (RP; n = 15), propofol sedation was administered per the usual routine of the anesthesiologist. In the targeted sedation group (TS; n = 25), sedation was titrated to an observer's assessment of alertness/sedation (OAA/S) score of 4 (ie, lethargic in response to name called) to 5 (ie, awake and alert). MEASUREMENTS: Both patient groups underwent processed electroencephalographic monitoring using bispectral index (BIS) intraoperatively. BIS levels were compared between groups to determine amount of surgical time spent in GA (BIS <or= 60). MAIN RESULTS: In the RP group, subjects spent 32.2% of surgical time at BIS levels consistent with GA. Although averaged BIS values during surgery increased from (mean +/- SD) 71 +/- 16 to 88 +/- 9 (P < 0.001), GA was still observed during 5% of surgical time in the TS group. Overall, 13 of 15 (87%) RP group patients and 11 of 25 (44%) TS group patients (P < 0.010) experienced some period of GA. CONCLUSIONS:BIS levels consistent with GA occur frequently in elderly patients during propofol-based sedation for spinal anesthesia. Altering routine practice such that sedation is titrated to a targeted clinically-determined sedation level reduces - but does not eliminate - this incidence. (c) 2010 Elsevier Inc. All rights reserved.
Authors: Hochang B Lee; Simon C Mears; Paul B Rosenberg; Jeannie-Marie S Leoutsakos; Allan Gottschalk; Frederick E Sieber Journal: J Am Geriatr Soc Date: 2011-12 Impact factor: 5.562
Authors: Jacqueline M Leung; Laura P Sands; Ningning Chen; Christopher Ames; Sigurd Berven; Kevin Bozic; Shane Burch; Dean Chou; Kenneth Covinsky; Vedat Deviren; Sakura Kinjo; Joel H Kramer; Michael Ries; Bobby Tay; Thomas Vail; Philip Weinstein; Stacey Chang; Gabriela Meckler; Stacey Newman; Tiffany Tsai; Vanessa Voss; Emily Youngblom Journal: Anesthesiology Date: 2017-10 Impact factor: 7.892
Authors: Frederick E Sieber; Khwaji J Zakriya; Allan Gottschalk; Mary-Rita Blute; Hochang B Lee; Paul B Rosenberg; Simon C Mears Journal: Mayo Clin Proc Date: 2010-01 Impact factor: 7.616