Comparisons between patient-controlled and anesthesiologist-controlled sedation with midazolam

Aim: Our purpose for this study was to compare patients' satisfaction and the clinical efficacy using midazolam for either patient-controlled or anesthesiologist-administered (usual sedation regimen in our hospital) conscious sedation during port placement. Material and Methods: One hundred adult patients (ASA I to III) scheduled for port placement were recruited according to a randomized, institutional review board approved protocol. Anesthesiologist-controlled group received iv. midazolam 0.03 mg kg^-1 and fentanil 1 μg kg^-1, 1 minute before commencement of the procedure. During the port placement an anesthetist administered further bolus doses of 1 mg midazolam when the patient expressed discomfort. In patient-controlled group, patients were also given the same drugs before the procedure. Then, during the intervention, patients were allowed to press demand button of the pump until they felt adequately sedated. Results: There were no differences between groups for vital signs, sedation doses, demands recorded by the machine (drug dose, volume, number of times demand button was pressed), degree of satisfaction, age, weight, gender and ASA status of the patients. Sedation scores at 3., 5., 10. and 15. minutes were significantly higher in Group H (patient). The median satisfaction scores for anesthesiologist-controlled group (0=unsatisfied; 10=completely satisfied) as assessed by the radiologists, and the patients were 10 (7-10) and 9 (6-10) points, respectively. The corresponding values for Group H, were 10 (7-10) and 10 (6-10) points, respectively. Conclusion: Compared with anesthesiologist-controlled sedation, patient-controlled sedation was associated with modestly greater patient satisfaction during port placement. Patient-controlled sedation for port placement may be an effective option for sedation that is associated with higher patient satisfaction.