https://scholars.lib.ntu.edu.tw/handle/123456789/192191
標題: | Postoperative Short-Term Sedation with Propofol in Cardiac Surgery Patients | 作者: | KO, WEN-JE HWANG, SHIOW-LI LIN, FANG-YUE WANG, SHOEI-SHEN TSAI, CHANG-HER CHU, SHU-HSUN |
公開日期: | 1999 | 卷: | v.98 | 期: | n.8 | 起(迄)頁: | 556-561 | 來源出版物: | JOURNAL OF THE FORMOSAN MEDICAL ASSOCIATION | 摘要: | We conducted a randomized double-blind study to assess the safety and effectiveness of short-term sedation with propofol in adult patients immediately after cardiac surgery . Sixty hemodynamically stable adult post-cardiac surgery patients were randomly assigned to receive prpofol or no postoperative sedation. The propofol group (N=30) received propofol infusion (1 mgkg-1hr-1) immediately after they awoke postoperatively. The care nurses adjusted the infusion rates to maintain a sedation level ( Ramsay score) of 3. The control group (N=30) received the same postoperative care, but without propofol sedation. The effectiveness of the sedative was assessed by nurses, according to Ramsay scores, as well as subjective evaluations by the patients. Postoperative pulmonary oxygenation dysfunction (PaO2/FiO2 < 300 mmHg) was noted in 10 experiment patients receiving propofol and in eight control group patients. The dysfunction was greatly improved after overnight ventilator support, and this improvement was not affected by propofol sedation. The propofol group received 13.65.3 hours of propofol infusion, with an infusion rate of 0 .960.16 mgkg-1hr-1. The propofol infusion rate needed to be adjusted once in six(20%) patients, twice in five(17%), and more than twice in two ; the rate did not need to be adjusted for the other 17(57%) patients. Patients receiving propofol remained well sedated (Ramsay score2) during 99.3% of the study period, while the control patients remained anxious or agitated (Ramsay score=1) during 12% of the study period. Patients receiving propofol could be successfully extubated 94 minutes after cessation of propofol infusion, without complications. All study patients could be transferred out of the intensive care unit before moon on the day of extubation, and the turnover of intensive care unit beds was not delayed by propofol sedation. Subjective evaluations ( scored on an analog scale: 0:nil, 10: extreme) revealed that patients receiving propofol felt less pain than those in the control group (2.32.7 vs 4.73.1, p<0.05), had better sleep quality (7.82.9 vs 5.12.9, p<0.05), and were more satisfied with the care they received (8.32.2 vs 5.83.9 , p<0.05). These findings suggest that propofol infusion is effective for short-term sedation of cardiac surgery patients postoperatively and that an infusion rate adequate to maintain a Ramsay score of 3 may be ideal. Given that control patients had apparently adequate sedation but still had poorer scores on subjective evaluations, postoperative sedation should be considered for all cardiac surgery patients, not only those with outward signs of anxiety or agitation. |
URI: | http://ntur.lib.ntu.edu.tw//handle/246246/91883 |
顯示於: | 醫學系 |
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