PATIENT-CONTROLLED PROPOFOL SEDATION FOR ELDERLY PATIENTS - SAFETY AND PATIENT ATTITUDE TOWARD CONTROL

Purpose: Little information is available regarding the use of patient- controlled sedation (PCS) among elderly patients undergoing operative procedures under local or regional anaesthesia. This prospective, rand omized study evaluated the safety of propofol PCS, and the attitude am ong elderly patients toward self-administration of sedation during cat aract surgery. Methods: Prospective, randomized study conducted in a U niversity affiliated, tertiary-care hospital. Fifty-five elderly patie nts (aged 65-79 yr) were randomized to receive propofol patient-contro lled sedation (PCS) (n = 28) or no intraoperative sedation (n = 27) du ring cataract surgery performed under peribulbar block. The PCS parame ters consisted of a lockout interval of three minutes and a PCS dose o f 0.3 ing . kg(-1). Study groups were compared with respect to sedatio n, anxiety and discomfort visual analogue scores (VAS), cognitive func tioning, patient satisfaction and the incidence of intraoperative comp lications. Results: Patients in the PCS group administered a mean prop ofol dose of 65 +/- 49 mg during procedures with a mean duration of 46 min. The incidence of intraoperative complications and sedation, anxi ety and discomfort VAS were similar between groups. Patient satisfacti on with PCS was high. In the PCS group, 10 (35%) of the 28 patients di d not use the device because they were comfortable and did not feel th ey needed sedation. Satisfaction was higher in the PCS group (P = 0.02 ), whether or not they used the PCS device, compared with patients who did not receive a PCS device. Conclusions: Propofol PCS represents a safe sedation technique among elderly patients in a monitored care set ting. Elderly patients appear to prefer the option of receiving some f orm of intraoperative sedation and respond favourably to the opportuni ty to control administration.