COMPARISON OF PROPOFOL ADMINISTRATION TECHNIQUES FOR SEDATION DURING MONITORED ANESTHESIA CARE

Sixty-three outpatients undergoing breast biopsy procedures with local anesthesia were randomly assigned to receive propofol by intermittent bolus injections (n = 21), a conventional syringe infusion pump (n = 21), or a target-controlled infusion (TCl) device (n = 21) for intraop erative sedation. In the first two groups, an initial intravenous (IV) bolus of propofol (0.3 mg/kg) was administered and an attempt was mad e to maintain the sedation level at an Observer's Assessment of Alertn ess/Sedation (OAA/S) score of 3 or 4 with either intermittent bolus in jections of propofol (10 mg) or a variable-rate infusion (25-100 mu g . kg(-1). min(-1)). In the TCl group, the initial target concentration of propofol was set at 2 mu g/mL and the target concentration was adj usted between 1 and 4 mu g/mL in an attempt to maintain an OAA/S score of 3 or 4. Recovery was assessed using clinical criteria, visual anal og scales (VAS), and the digit-symbol substitution test (DSST). The ov erall quality of sedation, operating conditions, and clinical recovery profiles were similar in all three treatment groups. The anesthesiolo gist had to intervene more frequently in the intermittent bolus inject ion group than in the two infusion groups. We conclude that the use of an infusion technique may allow the anesthesiologist more time for mo nitoring the patient by decreasing the number of interventions necessa ry to administer supplemental doses of the sedative medication during the operation. However, the cost of the IV drug delivery system may be come an increasingly important factor in the future.