Journal Mobile Options
Table of Contents
Vol. 19, No. 1, 2010
Issue release date: December 2009
Section title: Original Paper
Open Access Gateway
Med Princ Pract 2010;19:51–56
(DOI:10.1159/000252835)

Influence of Sedation on Patients’ Perceptions and Recovery in Patients Undergoing Minor Perianal Procedures under Spinal Saddle Block

Schmittner M.D.a · Janke C.a · Limmer M.E.a · Weiss C.b · Bussen D.G.c · Beck G.C.a
Departments of aAnaesthesiology and Critical Care Medicine and bMedical Statistics, University Medical Centre Mannheim, and cCentre of Coloproctology Mannheim, Mannheim, Germany
email Corresponding Author

Abstract

Objectives: Additional intra-operative sedation may help improve acceptability and comfort of anaesthesia in patients undergoing minor anorectal (perianal) procedures under spinal saddle block. This observational study was done to determine which patients request sedatives and to what extent sedatives affect the patients’ recovery. Subjects and Methods: During a 6-month period, 500 patients undergoing minor perianal procedures received 1.0 ml hyperbaric bupivacaine (0.5%). On request, a light sedation with propofol in bolus application was provided. Patients were evaluated postoperatively using a standardized questionnaire about their perceptions before, during and 48 h after the administration of anaesthesia. Results: More female (91/143, 63.6%) than male (136/259, 52.5%) patients (p = 0.0312) received sedation. Patients with sedation were significantly younger (46.7 ± 13.8 vs. 50 ± 13.8 years, p = 0.0171) and had a lower body mass index (BMI; 25.6 ± 4.3 vs. 27.5 ± 5.1, p < 0.0001). Time to mobilization and first micturition was significantly longer in patients with sedation (4.8 vs. 4.4 h, p = 0.0194 and 5.8 vs. 5.4 h, p = 0.0188), which was associated with a higher incidence of nausea (7.5 vs. 1.7%, p = 0.0083). Conclusions: Female gender, younger age, lower body weight and lower BMI were associated with higher subjective requirements for sedation. The use of sedation showed prolongation of time to first mobilization and micturition and a higher incidence of nausea.

© 2009 S. Karger AG, Basel


  

Key Words

  • Sedation
  • Perianal surgery
  • Spinal anaesthesia
  • Saddle block

References

  1. Bleday R, Pena JP, Rothenberger DA, Goldberg SM, Buls JG: Symptomatic hemorrhoids: current incidence and complications of operative therapy. Dis Colon Rectum 1992;35:477–481.
  2. Gudaityte J, Marchertiene I, Pavalkis D: Anesthesia for ambulatory anorectal surgery. Medicina (Kaunas) 2005;40:101–111.
  3. Li S, Coloma M, White PF, Watcha MF, Chiu JW, Li H, Huber PJ: Comparison of the cost and recovery profile of three anesthetic techniques for ambulatory anorectal surgery. Anesthesiology 2000;93:1225–1230.
  4. Kushwaha R, Hutchings W, Davies C, Rao NG: Randomized clinical trial comparing day-care open haemorrhoidectomy under local versus general anaesthesia. Br J Surg 2008;95:555–563.
  5. Korhonen AM: Use of spinal anaesthesia in day surgery. Curr Opin Anaesthesiol 2006; 19:612–616.
  6. Wassef MR, Michaels EI, Rangel JM, Tsyrlin AT: Spinal perianal block: a prospective, randomized, double-blind comparison with spinal saddle block. Anesth Analg 2007; 104:1594–1596.
  7. Hoehener D, Blumenthal S, Borgeat A: Sedation and regional anaesthesia in the adult patient. Br J Anaesth 2008;100:8–16.
  8. Wilson E, David A, MacKenzie N, Grant IS: Sedation during spinal anaesthesia: comparison of propofol and midazolam. Br J Anaesth 1990;64:48–52.
  9. White PF, Negus JB: Sedative infusions during local and regional anaesthesia: a comparison of midazolam and propofol. J Clin Anaesth 1991;3:32–39.
  10. Borgeat A, Wilder-Smith OHG, Saiah M, Rifat K: Subhypnotic doses of propofol possess direct antiemetic properties. Anaesth Analg 1992;74:539–541.
  11. Wu CL, Naqibuddin M, Fleisher LA: Measurement of patient satisfaction as an outcome of regional anesthesia and analgesia: a systematic review. Reg Anesth Pain Med 2001;26:196–208.
  12. Liu SS, Wu CL: The effect of analgesic technique on postoperative patient-reported outcomes including analgesia: a systemic review. Anesth Analg 2007;105:789–808.
  13. Chernik DA, Gillings D, Laine H, Hendler J, Silver JM, Davidson AB, Schwam EM, Siegel JL: Validity and reliability of the Observer’s Assessment of Alertness/Sedation Scale: study with intravenous midazolam. J Clin Psychopharmacol 1990;10:244–251.
  14. Aldrete JA, Kroulik D: A postanesthetic recovery score. Anesth Analg 1970;49:924–934.
  15. Trummel J: Sedation for gastrointestinal endoscopy: the changing landscape. Curr Opin Anaesthesiol 2007;20:359–364.
  16. Read TE, Henry SE, Hovis RM, Fleshman JW, Birnbaum EH, Caushaj PF, Kodner IJ: Prospective evaluation of anaesthetic technique for anorectal surgery. Dis Colon Rectum 2002;45:1553–1560.
  17. Sprung J, Bourke DL, Grass J, Hammel J, Mascha E, Thomas P, Tubin I: Predicting the difficult neuraxial block: a prospective study. Anesth Analg 1999;89:384–389.
  18. de Oliveiro Filho GR, Gomes HP, da Fonesca MHZ, Hoffman JC: Predictors of successful neuraxial block: a prospective study. J Eur Anaesthesiol 2002;19:447–451.
  19. Whiteside JB, Burke D, Wildsmith JAW: Comparison of ropivacaine 0.5% (in glucose 5%) with bupivacaine 0.5% (in glucose 8%) for spinal anaesthesia for elective surgery. Br J Anaesth 2003;90:304–308.
  20. Prasad ML, Abcarian H: Urinary retention following operations for benign anorectal diseases. Dis Colon Rectum 1978;21:490–492.
  21. Badner NH, Nielson WR, Munk S, Kwiatkowska C, Gelb AW: Preoperative anxiety: detection and contributing factors. Can J Anaesth 1990;37:444–447.
  22. Kindler CH, Harms C, Amsler F, Ihde-Scholl T, Scheidegger D: The visual analog scale allows effective measurement of preoperative anxiety and detection of patients’ anesthetic concerns. Anesth Analg 2000;90:706–712.
  23. Borgeat A, Ekatodramis G, Schenker CA: Postoperative nausea and vomiting in regional anaesthesia. Anaesthesiology 2003; 98:530–547.
  24. Van den Bosch JE, Moons KG, Bonsel GJ, Kalkman CJ: Does measurement of preoperative anxiety have added value for predicting postoperative nausea and vomiting? Anaesth Analg 2005;100:1525–1532.
  25. Hasen KV, Samartzis D, Casas LA, Mustoe TA: An outcome study comparing intravenous sedation with midazolam/fentanyl (conscious sedation) versus propofol infusion (deep sedation) for aesthetic surgery. Plast Reconstr Surg 2003;112:1683–1689.
  26. Villeret I, Laffon M, Ferrandiere M, Delerue D, Fusciardi J: Which propofol target concentration for ASA III elderly patients for conscious sedation combined with regional anaesthesia? Ann Fr Anesth Reanim 2003; 22:196–201.

  

Author Contacts

Marc D. Schmittner, MD
Department of Anaesthesiology and Critical Care Medicine, University Hospital Mannheim, Theodor-Kutzer-Ufer 1–3, DE–68167 Mannheim (Germany)
Tel. +49 621 383 2415, Fax +49 621 383 2164
E-Mail marc.schmittner@anaes.ma.uni-heidelberg.de

  

Article Information

Received: December 21, 2008
Revised: February 23, 2009
Published online: December 09, 2009
Number of Print Pages : 6
Number of Figures : 0, Number of Tables : 4, Number of References : 26

  

Publication Details

Medical Principles and Practice (International Journal of the Kuwait University Health Sciences Centre)

Vol. 19, No. 1, Year 2010 (Cover Date: December 2009)

Journal Editor: Owunwanne A. (Kuwait)
ISSN: 1011-7571 (Print), eISSN: 1423-0151 (Online)

For additional information: http://www.karger.com/MPP


Open Access License / Drug Dosage / Disclaimer

Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Objectives: Additional intra-operative sedation may help improve acceptability and comfort of anaesthesia in patients undergoing minor anorectal (perianal) procedures under spinal saddle block. This observational study was done to determine which patients request sedatives and to what extent sedatives affect the patients’ recovery. Subjects and Methods: During a 6-month period, 500 patients undergoing minor perianal procedures received 1.0 ml hyperbaric bupivacaine (0.5%). On request, a light sedation with propofol in bolus application was provided. Patients were evaluated postoperatively using a standardized questionnaire about their perceptions before, during and 48 h after the administration of anaesthesia. Results: More female (91/143, 63.6%) than male (136/259, 52.5%) patients (p = 0.0312) received sedation. Patients with sedation were significantly younger (46.7 ± 13.8 vs. 50 ± 13.8 years, p = 0.0171) and had a lower body mass index (BMI; 25.6 ± 4.3 vs. 27.5 ± 5.1, p < 0.0001). Time to mobilization and first micturition was significantly longer in patients with sedation (4.8 vs. 4.4 h, p = 0.0194 and 5.8 vs. 5.4 h, p = 0.0188), which was associated with a higher incidence of nausea (7.5 vs. 1.7%, p = 0.0083). Conclusions: Female gender, younger age, lower body weight and lower BMI were associated with higher subjective requirements for sedation. The use of sedation showed prolongation of time to first mobilization and micturition and a higher incidence of nausea.

© 2009 S. Karger AG, Basel


  

Author Contacts

Marc D. Schmittner, MD
Department of Anaesthesiology and Critical Care Medicine, University Hospital Mannheim, Theodor-Kutzer-Ufer 1–3, DE–68167 Mannheim (Germany)
Tel. +49 621 383 2415, Fax +49 621 383 2164
E-Mail marc.schmittner@anaes.ma.uni-heidelberg.de

  

Article Information

Received: December 21, 2008
Revised: February 23, 2009
Published online: December 09, 2009
Number of Print Pages : 6
Number of Figures : 0, Number of Tables : 4, Number of References : 26

  

Publication Details

Medical Principles and Practice (International Journal of the Kuwait University Health Sciences Centre)

Vol. 19, No. 1, Year 2010 (Cover Date: December 2009)

Journal Editor: Owunwanne A. (Kuwait)
ISSN: 1011-7571 (Print), eISSN: 1423-0151 (Online)

For additional information: http://www.karger.com/MPP


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 12/21/2008
Accepted: 2/23/2009
Published online: 12/9/2009
Issue release date: December 2009

Number of Print Pages: 6
Number of Figures: 0
Number of Tables: 4

ISSN: 1011-7571 (Print)
eISSN: 1423-0151 (Online)

For additional information: http://www.karger.com/MPP


Open Access License / Drug Dosage

Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Bleday R, Pena JP, Rothenberger DA, Goldberg SM, Buls JG: Symptomatic hemorrhoids: current incidence and complications of operative therapy. Dis Colon Rectum 1992;35:477–481.
  2. Gudaityte J, Marchertiene I, Pavalkis D: Anesthesia for ambulatory anorectal surgery. Medicina (Kaunas) 2005;40:101–111.
  3. Li S, Coloma M, White PF, Watcha MF, Chiu JW, Li H, Huber PJ: Comparison of the cost and recovery profile of three anesthetic techniques for ambulatory anorectal surgery. Anesthesiology 2000;93:1225–1230.
  4. Kushwaha R, Hutchings W, Davies C, Rao NG: Randomized clinical trial comparing day-care open haemorrhoidectomy under local versus general anaesthesia. Br J Surg 2008;95:555–563.
  5. Korhonen AM: Use of spinal anaesthesia in day surgery. Curr Opin Anaesthesiol 2006; 19:612–616.
  6. Wassef MR, Michaels EI, Rangel JM, Tsyrlin AT: Spinal perianal block: a prospective, randomized, double-blind comparison with spinal saddle block. Anesth Analg 2007; 104:1594–1596.
  7. Hoehener D, Blumenthal S, Borgeat A: Sedation and regional anaesthesia in the adult patient. Br J Anaesth 2008;100:8–16.
  8. Wilson E, David A, MacKenzie N, Grant IS: Sedation during spinal anaesthesia: comparison of propofol and midazolam. Br J Anaesth 1990;64:48–52.
  9. White PF, Negus JB: Sedative infusions during local and regional anaesthesia: a comparison of midazolam and propofol. J Clin Anaesth 1991;3:32–39.
  10. Borgeat A, Wilder-Smith OHG, Saiah M, Rifat K: Subhypnotic doses of propofol possess direct antiemetic properties. Anaesth Analg 1992;74:539–541.
  11. Wu CL, Naqibuddin M, Fleisher LA: Measurement of patient satisfaction as an outcome of regional anesthesia and analgesia: a systematic review. Reg Anesth Pain Med 2001;26:196–208.
  12. Liu SS, Wu CL: The effect of analgesic technique on postoperative patient-reported outcomes including analgesia: a systemic review. Anesth Analg 2007;105:789–808.
  13. Chernik DA, Gillings D, Laine H, Hendler J, Silver JM, Davidson AB, Schwam EM, Siegel JL: Validity and reliability of the Observer’s Assessment of Alertness/Sedation Scale: study with intravenous midazolam. J Clin Psychopharmacol 1990;10:244–251.
  14. Aldrete JA, Kroulik D: A postanesthetic recovery score. Anesth Analg 1970;49:924–934.
  15. Trummel J: Sedation for gastrointestinal endoscopy: the changing landscape. Curr Opin Anaesthesiol 2007;20:359–364.
  16. Read TE, Henry SE, Hovis RM, Fleshman JW, Birnbaum EH, Caushaj PF, Kodner IJ: Prospective evaluation of anaesthetic technique for anorectal surgery. Dis Colon Rectum 2002;45:1553–1560.
  17. Sprung J, Bourke DL, Grass J, Hammel J, Mascha E, Thomas P, Tubin I: Predicting the difficult neuraxial block: a prospective study. Anesth Analg 1999;89:384–389.
  18. de Oliveiro Filho GR, Gomes HP, da Fonesca MHZ, Hoffman JC: Predictors of successful neuraxial block: a prospective study. J Eur Anaesthesiol 2002;19:447–451.
  19. Whiteside JB, Burke D, Wildsmith JAW: Comparison of ropivacaine 0.5% (in glucose 5%) with bupivacaine 0.5% (in glucose 8%) for spinal anaesthesia for elective surgery. Br J Anaesth 2003;90:304–308.
  20. Prasad ML, Abcarian H: Urinary retention following operations for benign anorectal diseases. Dis Colon Rectum 1978;21:490–492.
  21. Badner NH, Nielson WR, Munk S, Kwiatkowska C, Gelb AW: Preoperative anxiety: detection and contributing factors. Can J Anaesth 1990;37:444–447.
  22. Kindler CH, Harms C, Amsler F, Ihde-Scholl T, Scheidegger D: The visual analog scale allows effective measurement of preoperative anxiety and detection of patients’ anesthetic concerns. Anesth Analg 2000;90:706–712.
  23. Borgeat A, Ekatodramis G, Schenker CA: Postoperative nausea and vomiting in regional anaesthesia. Anaesthesiology 2003; 98:530–547.
  24. Van den Bosch JE, Moons KG, Bonsel GJ, Kalkman CJ: Does measurement of preoperative anxiety have added value for predicting postoperative nausea and vomiting? Anaesth Analg 2005;100:1525–1532.
  25. Hasen KV, Samartzis D, Casas LA, Mustoe TA: An outcome study comparing intravenous sedation with midazolam/fentanyl (conscious sedation) versus propofol infusion (deep sedation) for aesthetic surgery. Plast Reconstr Surg 2003;112:1683–1689.
  26. Villeret I, Laffon M, Ferrandiere M, Delerue D, Fusciardi J: Which propofol target concentration for ASA III elderly patients for conscious sedation combined with regional anaesthesia? Ann Fr Anesth Reanim 2003; 22:196–201.