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CC BY-NC 4.0 · Arch Plast Surg 2017; 44(01): 5-11
DOI: 10.5999/aps.2017.44.1.5
Original Article

Variables Influencing the Depth of Conscious Sedation in Plastic Surgery: A Prospective Study

Hyeonjung Yeo
Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital, Daegu, Korea
,
Wonwoo Kim
Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital, Daegu, Korea
,
Hyochun Park
Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital, Daegu, Korea
,
Hoonnam Kim
Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital, Daegu, Korea
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Background Conscious sedation has been widely utilized in plastic surgery. However, inadequate research has been published evaluating adequate drug dosage and depth of sedation. In clinical practice, sedation is often inadequate or accompanied by complications when sedatives are administered according to body weight alone. The purpose of this study was to identify variables influencing the depth of sedation during conscious sedation for plastic surgery.

Methods This prospective study evaluated 97 patients who underwent plastic surgical procedures under conscious sedation. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, and glucose levels were measured. Midazolam and ketamine were administered intravenously according to a preset protocol. Bispectral index (BIS) recordings were obtained to evaluate the depth of sedation 4, 10, 15, and 20 minutes after midazolam administration. Associations between variables and the BIS were assessed using multiple regression analysis.

Results Alcohol intake and female sex were positively associated with the mean BIS (P<0.01). Age was negatively associated with the mean BIS (P<0.01). Body mass index (P=0.263), creatinine clearance (P=0.832), smoking history (P=0.398), glucose (P=0.718), AST (P=0.729), and ALT (P=0.423) were not associated with the BIS.

Conclusions Older patients tended to have a greater depth of sedation, whereas females and patients with greater alcohol intake had a shallower depth of sedation. Thus, precise dose adjustments of sedatives, accounting for not only weight but also age, sex, and alcohol consumption, are required to achieve safe, effective, and predictable conscious sedation.

Keywords

Conscious sedation - Deep sedation - Hypnotics and sedatives - Consciousness monitors

This article was presented at the Fifth Research & Reconstructive Forum on May 14, 2015 in Pyeongchang, Korea.




Publication History

Received: 13 August 2016

Accepted: 20 October 2016

Article published online:
20 April 2022

© 2017. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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  • REFERENCES

  • 1 Pollock H, Forman S, Pollock T. et al. Conscious sedation/local anesthesia in the office-based surgical and procedural facility. Clin Plast Surg 2013; 40: 383-388
    CrossrefPubMedGoogle Scholar
  • 2 Li YH, He R, Ruan JG. Effect of hepatic function on the EC50 of midazolam and the BIS50 at the time of loss of consciousness. J Zhejiang Univ Sci B 2014; 15: 743-749
    PubMedGoogle Scholar
  • 3 Yi Y, Heo D, Son HJ. et al. Association between bispectral index and age and use of sedative drugs in high spinal anaesthesia. J Int Med Res 2013; 41: 378-385
    Google Scholar
  • 4 Brill MJ, Diepstraten J, van Rongen A. et al. Impact of obesity on drug metabolism and elimination in adults and children. Clin Pharmacokinet 2012; 51: 277-304
    CrossrefPubMedGoogle Scholar
  • 5 Steven RK, Catherine RM, Brian G. et al. Does alcohol consumption impact conscious sedation during endoscopy?. Gastrointest Endosc 2001; 53: AB84
    Google Scholar
  • 6 Mustoe TA, Kim P, Schierle CF. Outpatient abdominoplasty under conscious sedation. Aesthet Surg J 2007; 27: 442-449
    CrossrefPubMedGoogle Scholar
  • 7 Veselis RA, Reinsel RA, Feshchenko VA. Drug-induced amnesia is a separate phenomenon from sedation: electrophysiologic evidence. Anesthesiology 2001; 95: 896-907
    CrossrefPubMedGoogle Scholar
  • 8 Rogers R, Wise RG, Painter DJ. et al. An investigation to dissociate the analgesic and anesthetic properties of ketamine using functional magnetic resonance imaging. Anesthesiology 2004; 100: 292-301
    CrossrefPubMedGoogle Scholar
  • 9 Gruber RP, Morley B. Ketamine-assisted intravenous sedation with midazolam: benefits and potential problems. Plast Reconstr Surg 1999; 104: 1823-1825
    CrossrefPubMedGoogle Scholar
  • 10 Morioka N, Ozaki M, Matsukawa T. et al. Ketamine causes a paradoxical increase in the bispectral index. Anesthesiology 1997; 87: A502
    CrossrefGoogle Scholar
  • 11 Nonaka A, Makino K, Suzuki S. et al. Low doses of ketamine have no effect on bispectral index during stable propofol-remifentanil anesthesia. Masui 2012; 61: 364-367
    PubMedGoogle Scholar
  • 12 Glass PS, Bloom M, Kearse L. et al. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology 1997; 86: 836-847
    CrossrefPubMedGoogle Scholar
  • 13 Bell JK, Laasch HU, Wilbraham L. et al. Bispectral index monitoring for conscious sedation in intervention: better, safer, faster. Clin Radiol 2004; 59: 1106-1113
    CrossrefPubMedGoogle Scholar
  • 14 Pleym H, Spigset O, Kharasch ED. et al. Gender differences in drug effects: implications for anesthesiologists. Acta Anaesthesiol Scand 2003; 47: 241-259
    Google Scholar
  • 15 Gan TJ, Glass PS, Sigl J. et al. Women emerge from general anesthesia with propofol/alfentanil/nitrous oxide faster than men. Anesthesiology 1999; 90: 1283-1287
    CrossrefPubMedGoogle Scholar
  • 16 Yen YH, Lin TF, Lin CJ. et al. Sex differences in conscious sedation during upper gastrointestinal panendoscopic examination. J Formos Med Assoc 2011; 110: 44-49
    CrossrefPubMedGoogle Scholar
  • 17 Katoh T, Suguro Y, Ikeda T. et al. Influence of age on awakening concentrations of sevoflurane and isoflurane. Anesth Analg 1993; 76: 348-352
    PubMedGoogle Scholar
  • 18 Yamashita K, Terao Y, Inadomi C. et al. Age-dependent relationship between bispectral index and sedation level. J Clin Anesth 2008; 20: 492-495
    CrossrefPubMedGoogle Scholar
  • 19 Avram MJ, Fragen RJ, Caldwell NJ. Midazolam kinetics in women of two age groups. Clin Pharmacol Ther 1983; 34: 505-508
    CrossrefPubMedGoogle Scholar
  • 20 Adler M, Schaffner F. Fatty liver hepatitis and cirrhosis in obese patients. Am J Med 1979; 67: 811-816
    CrossrefPubMedGoogle Scholar
  • 21 Haeck PC, Swanson JA, Iverson RE. et al. Evidence-based patient safety advisory: patient selection and procedures in ambulatory surgery. Plast Reconstr Surg 2009; 124: 6s-27s
    CrossrefPubMedGoogle Scholar
  • 22 Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease [Internet]. New York: KDIGO; 2013. cited 2016 Nov 28 Available from:. http://www.kdigo.org/clinical_practice_guidelines/pdf/CKD/KDIGO_2012_CKD_GL.pdf
    Google Scholar
  • 23 Dostalek M, Akhlaghi F, Puzanovova M. Effect of diabetes mellitus on pharmacokinetic and pharmacodynamic properties of drugs. Clin Pharmacokinet 2012; 51: 481-499
    CrossrefPubMedGoogle Scholar
  • 24 Kroon LA. Drug interactions with smoking. Am J Health Syst Pharm 2007; 64: 1917-1921
    CrossrefPubMedGoogle Scholar
  • 25 Joshi GP, Ahmad S, Riad W. et al. Selection of obese patients undergoing ambulatory surgery: a systematic review of the literature. Anesth Analg 2013; 117: 1082-1091
    CrossrefPubMedGoogle Scholar