Sedation in elderly patient undergoing surgery with spinal anesthesia: propofol vs. midazolam

It is widely known the need for a high quality sedation associated with local regional anesthesia in elderly patients’ surgery. The aim of this study was to compare two sedation regimes: propofol and midazolam, associated to spinal anesthesia with isobaric 0.5% bupivacaine in lower abdominal surgery in elderly patients. After obtaining the informed consent, 60 patients aged between 65 and 82 years old (ASA I-III), scheduled for unilateral hernioplasty , under spinal anesthesia with isobaric bupivacaine 1,5 ml (0.5%), were randomized into two groups of 30 patients each: P group - patients received propofol 3mg/kg/body/hour in the first 10 minutes and then continuous infusion by injection of 1,8 mg/kg/body/hour, and group M-patients who have received midazolam 0,2mg/kg/body/hour in the first 10 minutes and then continuous infusion by injection of 0,15 mg/kg/body/hour. In order to achieve a similar level of sedation we used 0,1% midazolam infusion and 1% propofol. Intraoperative, the following have been monitored: heart rate and breath, mean arterial pressure, hemoglobin oxygen saturation. We have also recorded the sedation score (modified Wilson sedation scale), awakening times, patient satisfaction at 24 hours (satisfaction score according to Iowa University). The average score of sedation for group P was of 3,24 ± 0,23, compared to 2,64 ±0,42 in group M (p = 0.001). Both drugs reduce blood pressure, but not more than 20% of the initial value. There are no significant differences in the satisfaction score of the patient (p = 0,18). There was just one case of respiratory depression in group M with the decrease of SpO2 at 86%.Sedation with propofol associated with local regional anesthesia techniques in elderly patients seems to provide better conditions in terms of sedation score and lack of

respiratory depression compared with the administration of midazolam. Recovery was significantly faster after sedation with propofol. The satisfaction score of the patient was similar in the two groups