Is sedation necessary for demented patients under infiltration anesthesia?

Sedation for intraoperative patients under infiltration anesthesia is often used, however, disadvantages of sedation for demented patients may sometimes exceed its advantages because some of the demented patients are already apathetic about their surroundings. The authors prospectively investigated whether sedation for alert or demented patients receiving surgery under infiltration anesthesia is useful and safe for intraoperative management.

Sixty patients undergoing irrigation and drainage of chronic subdural hematoma under infiltration anesthesia were divided into four groups. Patients in Group A were non-sedated alert patients. Patients in Group B were non-sedated demented patients. Patients in Group C were sedated alert patients. Patients in Group D were sedated demented patients. Intraoperative variables, adverse effects, and the postoperative satisfaction represented by five-point score were recorded.

The heart rate in group A during operation was significantly faster than the control value. The postoperative satisfaction score in group A was significantly lower than any other groups. A patient in group D required a nasal airway to improve respiration during operation.

These results suggest that there is no evidence to show that advantages of sedation for demented surgical patients under infiltration anesthesia excel the disadvantages although sedation for alert patients may be an effective and rational conduct in intraoperative management.