Sedation in hypoalbuminemic geriatric patients under spinal anesthesia in hip surgery. Midazolam or Propofol?

• Published in: Saudi medical journal 2015-10, Vol.36 (10), p.1191-1198
• Main Authors: Ersoy, Ayşın, Kara, Deniz, Ervatan, Zekeriya, Çakırgöz, Mensure, Kıran, Özlem
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aged, 80 and over; Anesthesia; Anesthesia Recovery Period; Anesthesia, Spinal; Arthroplasty, Replacement, Hip; Elderly patients; Female; Heart rate; Hemodynamics - drug effects; Humans; Hypnotics and Sedatives - administration & dosage; Hypnotics and Sedatives - adverse effects; Hypoalbuminemia; Infusions, Intravenous; Injections, Intravenous; Intraoperative Complications - chemically induced; Male; Midazolam; Midazolam - administration & dosage; Midazolam - adverse effects; Original; Patient Satisfaction; Phenols (Class of compounds); Postoperative Complications - chemically induced; Propofol; Propofol - administration & dosage; Propofol - adverse effects; Prospective Studies; Respiratory Insufficiency - chemically induced; Surgery
• ISSN: 0379-5284; 1658-3175
• DOI: 10.15537/smj.2015.10.12403

To compare midazolam and propofol sedation in hypoalbuminemic geriatric patients under spinal anesthesia in hip surgery with bispectral index monitoring. This prospective and randomized study was completed in the Department of Anesthesiology, Okmeydani Training and Research Hospital, Istanbul, Turkey between February 2013 and December 2014. Sixty patients undergoing elective hip surgery under spinal anesthesia in the geriatric age group with albumin levels below 3 g/dl were randomly divided into Group I and Group II. After administration of spinal block, Group I were given 0.05 mg/kg bolus midazolam, and then 0.02-0.1 mg/kg/hr dose infusion was begun. In Group II, 1 mg/kg bolus propofol was given within 10 minutes, and then 1-3 mg/kg/hr infusion was begun. The systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, heart rate, peripheral oxygen saturation values, respiratory rate, and Wilson's 5-stage sedation score were recorded at 15-minute intervals. At the end of the operation, the recovery time and surgeon satisfaction were recorded. The recovery times for patients in Group I were found to be longer than in Group II (p less than 0.05). The respiration rate in patients in Group I at the start of surgery, 15th minute of surgery, and after surgery were lower than in Group II (p less than 0.05). We conclude that propofol is more reliable in terms of hemodynamic stability than midazolam, as it causes less respiratory depression and faster recovery in the propofol group.