Kyung-Il Hwang, M.D., Sang-Ho Lee, M.D.
Background: During
percutaneous endoscopic lumbar discectomies (PELDs), the patients must be able
to respond to the surgeons who are very anxious about damaging spinal roots and
cords. Therefore, the surgeons must keep asking the patients whether there are
any pains or motor weaknesses in legs. For that reason, any patient cannot have
deep sedation and complete analgesia. Consequently, the patients may have
painful and awful memories. The purpose of this study was to evaluate whether
the conscious sedation using target-controlled infusion (TCI) with propofol can
solve these problems.
Methods: Ten
patients scheduled to take PELDs were assigned to this test. The ages of
patients were from 27 to 73. As soon as the surgeon began to process the
operation, TCI of propofol was started at a target plasma level of 1.0 mg/ml adjusted in steps of 0.1 mg/ml to maintain a sedation level 3 on a 5-point sedation scale. 5
L/min of oxygen was supplied to the patients through the nasal cannula.
Results:
Eight patients were satisfied with the anesthesia of TCI using propofol. Two
patients ran into the sedation level 4 and could not communicate with the
surgeons though the target plasma levels were 0.9 and 1.0 mg/ml at that moment. We failed in conscious sedation of those
patients. Their ages were 73 and 68. The mean target concentration range of
eight patients who took the operations well was from 0.9 mg/ml to 1.3 mg/ml.
They did not recall any painful memories. Their ages were from 27 to 59.
Conclusions:
We may have the conclusion that TCI using propofol can protect the patients who
are less than 60 years old from the painful and awful memory during the surgery
such as a PELD, but we must have further study for patients group who are more
than 60 years old.
References: A. Roode, et al. Anesth & Analg 2000;91:1056-1061