Journal of Postgraduate Medicine Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India ISSN: 0022-3859 EISSN: 0972-2823 Vol. 55, Num. 2, 2009, pp. 91-91

Journal of Postgraduate Medicine, Vol. 55, No. 2, April-June, 2009, pp. 91

Guest Editorial

To be awake or not to be…

Cattano D

Department of Anesthesiology, Memorial Hermann Hospital, UTHSC-Houston, School of Medicine
Correspondence Address:Department of Anesthesiology, Memorial Hermann Hospital, UTHSC-Houston, School of Medicine
davide.cattano@uth.tmc.edu

Code Number: jp09026

PMID: 19550051
DOI: 10.4103/0022-3859.52838

The standard of care of patients receiving regional anesthesia has changed in the last 10 years dramatically. The perception about the need for supplemental analgo-sedation, however, from both the public and the anesthesiologist remains equivocal in some instances. Cultural differences, gender, medical setting, and surgical procedures modulate the necessity of patient comfort, stress reduction, and even surgeon and staff preferences towards a controlled sedation. ^[1],[2] However, is the patient getting what he/she really needs?

The recent article by Tripathi et al ., ^[3] provides a well-organized analysis of the current knowledge in patient controlled infusional sedation which is integrated with data from an Indian cohort.

While a few attempts to replace the expert control on infusional sedation by non-anesthesiologist are raising concerns in the specialty, the article gets into the details of what patients of different ages, different gender, and different social background would like and perceive as a good care by the anesthesiologist in creating a warm and comfortable environment and in coping with the surgical procedure.

Evidence indicates that a good regional, epidural or spinal block can affect the level of alertness and consequently reduce the emotional and physical stress in surgical patients. ^[4] However, Tripathi et al., have shown that patients controlling their own sedation suffer from considerable discomfort. It is interesting to note that anxiety in operating room atmosphere (39%) was one of the important reasons for not activating patient-controlled infusion pump.

Recent research has shown that propofol acts on the phosphorilation site of the NMDA glutamanergic receptor, ^[5] and it would be interesting to compare the efficacy of propofol and propofol-ketamine or propofol-fentanyl combination in providing analgesia and post-operative pain control.

Tripathi et al . need to be complimented for their research on perioperative comfort under regional anesthesia, patient controlled strategies in perioperative care, and for discussing possible pain research avenues.

References

1.	Rudkin GE, Osborne GA, Finn BP, Jarvis DA, Vickers D. Intra-operative patient-controlled sedation. Comparison of patient-controlled propofol with patient-controlled midazolam. Anaesthesia 1992;47:376-81.  Back to cited text no. 1
2.	Hφhener D, Blumenthal S, Borgeat A. Sedation and regional anaesthesia in the adult patient. Br J Anaesth 2008;100:8-16.  Back to cited text no. 2
3.	Tripathi M, Nath SS, Chaudhary A, Singh PK, Pandey CM. Patient controlled sedation during central neuraxial anesthesia. J Postgrad Med 2009;55:108-12.  Back to cited text no. 3  [PUBMED]
4.	Doufas AG, Wadhwa A, Shah YM, Lin CM, Haugh GS, Sessler DI. Block-dependent sedation during epidural anaesthesia is associated with delayed brainstem conduction. Br J Anaesth 2004;93:228-34.  Back to cited text no. 4
5.	Kingston S, Mao L, Yang L, Arora A, Fibuch EE, Wang JQ. Propofol inhibits phosphorylation of N-methyl-D-aspartate receptor NR1 subunits in neurons. Anesthesiology 2006;104:763-9.  Back to cited text no. 5

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