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Light vs. heavy sedation during mechanical ventilation after oesophagectomy – a pilot experimental study focusing on memory
Author(s) -
SAMUELSON K. A. M.,
LUNDBERG D.,
FRIDLUND B.
Publication year - 2008
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2008.01702.x
Subject(s) - medicine , sedation , mechanical ventilation , randomized controlled trial , anesthesia , propofol , intensive care unit , regimen , confidence interval , ventilation (architecture) , surgery , intensive care medicine , mechanical engineering , engineering
Background: To assess and compare the feasibility and stressful memories of light vs. heavy sedation during post‐operative mechanical ventilation. Methods: Randomized clinical trial in one general intensive care unit (ICU) in a Swedish university hospital. Thirty‐six adults were randomly assigned to receive either light [Motor Activity Assessment Scale (MAAS) 3–4] or heavy (MAAS 1–2) sedation with continuous i.v. infusion of propofol during post‐operative invasive mechanical ventilation after oesophagectomy. The patients were interviewed at the general ward 5 days post‐ICU using the ICU Memory Tool and the ICU Stressful Experience Questionnaire, and 2 months post‐ICU using the Impact of Event Scale Revised. Patient data and hourly recorded MAAS values were collected after the interviews. Results: Seventy‐four per cent of the 139 MAAS values in the light sedation group ( n =18) and 79% of the 142 in the heavy sedation group ( n =18) were within the targeted levels, and the median MAAS scores were 3.0 vs. 1.25, respectively. Intention‐to‐treat analyses showed no significant difference in the prevalence of stressful memories between groups, including endotracheal tube discomfort, presenting wide 95% confidence intervals for the difference in outcome estimates. Excluding the patients with a prolonged ICU stay ( n =3), a higher prevalence of delusional memories was found in the heavy sedation group (31% vs. 0%, P =0.04). Conclusions: This small randomized‐controlled pilot study suggests that a light sedation regimen during short‐term post‐operative mechanical ventilation after major surgery is feasible without increasing patient discomfort.