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Sedation during spinal anesthesia.

J E Pollock1, J M Neal, S S Liu

  • 1Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, USA.

Anesthesiology
|September 2, 2000
PubMed
Summary
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Spinal anesthesia causes progressive sedation, as measured by Observer's Assessment of Alertness/Sedation Scale (OAA/S) scores, which may involve delayed mechanisms. The Bispectral Index (BIS) monitor was not sensitive to this sedation in a blinded study.

Area of Science:

  • Anesthesiology
  • Neuroscience

Background:

  • Central neuraxial anesthesia is known to reduce the need for other anesthetic agents.
  • This effect is hypothesized to result from reduced stimulation of the reticular activating system.

Purpose of the Study:

  • To quantify the sedative effects of spinal anesthesia using the Bispectral Index (BIS) monitor.
  • To investigate the potential mechanisms of sedation associated with spinal anesthesia.

Main Methods:

  • A two-part study involving unmedicated volunteers.
  • Part I: Non-randomized pilot study with BIS and Observer's Assessment of Alertness/Sedation Scale (OAA/S) monitoring before and after spinal anesthesia.
  • Part II: Randomized, double-blind, placebo-controlled study with BIS and OAA/S monitoring in volunteers receiving spinal anesthesia or placebo.

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Main Results:

  • Part I showed progressive changes in BIS scores after spinal anesthesia.
  • Part II revealed significant decreases in OAA/S and self-sedation scores in the spinal anesthesia group compared to placebo.
  • BIS scores did not significantly differ between the spinal anesthesia and placebo groups in Part II.

Conclusions:

  • Spinal anesthesia induces progressive sedation, confirmed by OAA/S and self-sedation scores, independent of block height.
  • A delayed sedation effect observed at 60 minutes suggests potential secondary mechanisms, possibly related to local anesthetic spread.
  • The BIS monitor demonstrated limited sensitivity in measuring spinal anesthesia-induced sedation in the blinded study setting.