Comparison of target controlled infusion and manual infusion of propofol for sedation in spinal anesthesia

Abstract

Abstract Objective The purpose of this study was to compare the quality of sedation during surgery under spinal anesthesia with propofol using target-controlled infusion versus manual infusion regarding sedation, hemodynamics, recovery pattern, and patient and surgeon satisfaction. Subjects and methods This prospective randomized controlled study was performed on 60 ASA I–III patients enrolled for elective surgery under spinal anesthesia. They received propofol infusion for intraoperative sedation using target-controlled infusion or manually. The target-controlled infusion group (n = 30) received propofol with the target-controlled infusion system (Schnider’s model) with the initial target plasma concentration set at 1.5 μg ml−1. The manual infusion group (n = 30) received propofol manually in a bolus of 0.5 mg kg−1 and in maintenance doses of 1.5 mg kg−1 h−1. In both groups, the anesthesiologist adjusted to increase or decrease the infusion rate by 0.2 μg ml−1 to maintain an Observer’s Assessment of Alertness and Sedation Scale of 3–4. We recorded the amount of propofol, hemodynamics, sedation scores, VAS, BIS, patient’s and surgeon’s satisfaction, recovery pattern, and side effects. Results Compared with the manual infusion group, the target-controlled infusion group had a faster time to reach OAAS/3 (7.2 ± 3.47 min for the target-controlled infusion group vs 5.8 ± 1.50 min for the manual infusion group; p = 0.04) and recovery time (5.1 ± 1.70 min vs 3.6 ± 1.09 min; p < 0.001); deeper BIS levels in the 10th, 20th, and 30th minutes (p = 0.04, p = 0.03, p = 0.05); and deeper Observer’s Assessment of Alertness and Sedation Scale in the 10th and 40th minutes (p = 0.05, p = 0.03), and more surgeon’s satisfaction (p = 0.05). Conclusion It was concluded that propofol at the same doses administered with target-controlled infusion for sedation during spinal anesthesia could be preferred due to faster sedation and recovery and more patient’s satisfaction compared to manual infusion.