Psychomotor Responses to Independent Visual, Auditory and Tactile Electrical stimuli during Sevoflurane sedation (PRIVATES)
File(s)
Published version
Author(s)
Hollmann, Vivien C
Darwood, Alastair RJ
Sarai, Pawandeep S
Strutton, Paul H
Harrop-Griffiths, William
Type
Journal Article
Abstract
Background
Patient-controlled sedation has potential benefits, including rapid recovery and improved patient satisfaction. During patient-controlled sedation, the recipient presses a button to self-administer the sedative. The safety and efficacy of this method is dependent upon the dose relationships between the sedative's desired effects, its impact on the ability to press a button, and adverse effect occurrence. This study aimed to investigate the relationship between sedation, psychomotor function, and adverse effect occurrence during clinician-controlled sevoflurane sedation.
Methods
15 healthy participants (10 males) were administered a sevoflurane dose-escalation protocol starting at 0 kPa and increasing in 0.2 kPa increments until a protocol endpoint occurred. Sevoflurane was delivered using conventional anaesthetic apparatus. At each sevoflurane dose, Richmond Agitation-Sedation Scale (RASS) and psychomotor function were assessed. Protocol endpoints included airway, respiratory, or cardiovascular compromise; agitation (RASS ≥+2); and sedation >3 h.
Results
The protocol endpoint was sedation >3 h for nine (60%) participants, agitation for five (33%) participants, and tonic movements for one (7%) participant. The median [range] sevoflurane dose was 0.4 [0.2–1.0] kPa when RASS <0 (sedation dose), 1.2 [0.6–2.0] kPa when participants were unable to complete reaction time testing (button-press dose), and 1.6 [1.2–2.2] kPa at the protocol endpoint (endpoint dose). The sedation dose was less than the button-press dose (P<0.0001), and the button-press dose was less than the endpoint dose (P=0.002).
Conclusions
Patient-controlled sevoflurane sedation is potentially feasible in a healthy population within the dose range 0.4–1.2 kPa. Concurrent reaction time monitoring could minimise the risk of agitation.
Patient-controlled sedation has potential benefits, including rapid recovery and improved patient satisfaction. During patient-controlled sedation, the recipient presses a button to self-administer the sedative. The safety and efficacy of this method is dependent upon the dose relationships between the sedative's desired effects, its impact on the ability to press a button, and adverse effect occurrence. This study aimed to investigate the relationship between sedation, psychomotor function, and adverse effect occurrence during clinician-controlled sevoflurane sedation.
Methods
15 healthy participants (10 males) were administered a sevoflurane dose-escalation protocol starting at 0 kPa and increasing in 0.2 kPa increments until a protocol endpoint occurred. Sevoflurane was delivered using conventional anaesthetic apparatus. At each sevoflurane dose, Richmond Agitation-Sedation Scale (RASS) and psychomotor function were assessed. Protocol endpoints included airway, respiratory, or cardiovascular compromise; agitation (RASS ≥+2); and sedation >3 h.
Results
The protocol endpoint was sedation >3 h for nine (60%) participants, agitation for five (33%) participants, and tonic movements for one (7%) participant. The median [range] sevoflurane dose was 0.4 [0.2–1.0] kPa when RASS <0 (sedation dose), 1.2 [0.6–2.0] kPa when participants were unable to complete reaction time testing (button-press dose), and 1.6 [1.2–2.2] kPa at the protocol endpoint (endpoint dose). The sedation dose was less than the button-press dose (P<0.0001), and the button-press dose was less than the endpoint dose (P=0.002).
Conclusions
Patient-controlled sevoflurane sedation is potentially feasible in a healthy population within the dose range 0.4–1.2 kPa. Concurrent reaction time monitoring could minimise the risk of agitation.
Date Issued
2025-05-01
Date Acceptance
2025-01-03
Citation
British Journal of Anaesthesia, 2025, 134 (5), pp.1341-1349
ISSN
0007-0912
Publisher
Elsevier BV
Start Page
1341
End Page
1349
Journal / Book Title
British Journal of Anaesthesia
Volume
134
Issue
5
Copyright Statement
© 2025 The Author(s). Published by Elsevier Ltd on behalf of British Journal of Anaesthesia. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/40113477
PII: S0007-0912(25)00103-5
Subjects
analgesia
patient-controlled sedation
psychomotor
recall
sedation
sevoflurane
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2025-03-19