Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-24T07:02:06.907Z Has data issue: false hasContentIssue false
  • English
  • Français

Study on the usefulness of precise and simple dynamic balance tests for the evaluation of recovery from intravenous sedation with midazolam and propofol

Published online by Cambridge University Press:  01 May 2007

T. Fujisawa ,
S. Takuma ,
H. Koseki ,
K. Kimura  and
K. Fukushima
T. Fujisawa*
Affiliation:
Hokkaido University, Graduate School of Dental Medicine, Department of Dental Anesthesiology, Sapporo, Japan
S. Takuma
Affiliation:
Hokkaido University, Graduate School of Dental Medicine, Department of Dental Anesthesiology, Sapporo, Japan
H. Koseki
Affiliation:
Hokkaido University, Graduate School of Dental Medicine, Department of Dental Anesthesiology, Sapporo, Japan
K. Kimura
Affiliation:
Hokkaido University, Graduate School of Dental Medicine, Department of Dental Anesthesiology, Sapporo, Japan
K. Fukushima
Affiliation:
Hokkaido University, Graduate School of Dental Medicine, Department of Dental Anesthesiology, Sapporo, Japan
*
Correspondence to: Toshiaki Fujisawa, Department of Dental Anesthesiology, Graduate School of Dental Medicine, Hokkaido University, Kita-13 Nishi-7, Kita-ku, Sapporo 060-8586, Japan. E-mail: [email protected]; Tel: +81 11 706 3738; Fax: +81 11 706 3738
Get access

Summary

Background and objective

Dynamic balance involving movement of the centre of gravity is important for the evaluation of street fitness after sedation. The purpose of this study was to compare the recovery of dynamic balance after intravenous sedation with propofol or midazolam, and to investigate the usefulness of simple dynamic balance tests in evaluating the recovery.

Methods

Fourteen young male volunteers underwent intravenous sedation with propofol and midazolam for 1 h each at an interval of more than 1 week. Computerized dynamic posturography using a multi-axial tilting platform, the 10-m maximum-speed walking test and the timed ‘up & go’ test (subjects stand up from a chair, walk 5 m and back with maximum speed and sit down again) were performed before and after sedation. The increase in each variable of the tests described above represents a reduction of function.

Results

The score of the computerized dynamic posturography was significantly lower in propofol sedation than that in midazolam sedation until 40 min after the end of sedation (P = 0.006). The scores of maximum-speed walking test and timed ‘up & go’ test were significantly lower in propofol sedation than those in midazolam sedation till 60 min after the end of sedation, respectively (P = 0.035 and 0.042). The timed ‘up & go’ and maximum-speed walking tests were well and significantly correlated with computerized dynamic posturography in midazolam sedation (timed ‘up & go’ test vs. computerized dynamic posturography: r = 0.66, P < 0.01; and maximum-speed walking test vs. computerized dynamic posturography: r = 0.53, P < 0.01).

Conclusion

The timed ‘up & go’ and maximum-speed walking tests are useful simple dynamic balance tests well correlated with precise computerized dynamic posturography for the evaluation of the recovery of dynamic balance from midazolam sedation in younger adults.

Keywords

CONSCIOUS SEDATIONPROPOFOLMIDAZOLAMRECOVERY OF FUNCTIONMUSCULOSKELETAL EQUILIBRIUM, dynamic balance, computerized dynamic posturography
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 5 , May 2007 , pp. 425 - 430
Copyright
Copyright © European Society of Anaesthesiology 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Avramov, MN, Smith, I, White, PF. Interactions between midazolam and remifentanil during monitored anesthesia care. Anesthesiology 1996; 85: 1283–1289.CrossRefGoogle ScholarPubMed
2.Janzen, PR, Christys, A, Vucevic, M. Patient-controlled sedation using propofol in elderly patients in day-case cataract surgery. Br J Anaesth 1999; 82: 635–636.Google Scholar
3.Wilson, E, David, A, Mackenzie, N, Grant, IS. Sedation during spinal anaesthesia: Comparison of propofol and midazolam. Br J Anaesth 1990; 64: 48–52.Google Scholar
4.Polster, MR, Gray, PA, O’sullivan, G, Mccarthy, RA, Park, GR. Comparison of the sedative and amnesic effects of midazolam and propofol. Br J Anaesth 1993; 70: 612–616.Google Scholar
5.Fujisawa, T, Takuma, S, Koseki, H, Kimura, K, Fukushima, K. Assessment of the recovery of dynamic balance after intravenous sedation with midazolam. J Anesth 2005; 19: 26–30.CrossRefGoogle ScholarPubMed
6.Marsh, B, White, M, Morton, N, Kenny, GN. Pharmacokinetic model driven infusion of propofol in children. Br J Anaesth 1991; 67: 41–48.CrossRefGoogle ScholarPubMed
7.Suzuki, K, Imada, G, Iwaya, T, Handa, T, Kurogo, H. Determinants and predictors of the maximum walking speed during computer-assisted gait training in hemiparetic stroke patients. Arch Phys Med Rehabil 1999; 80: 179–182.Google Scholar
8.Shimada, H, Obuchi, S, Kakurai, S, Uchiyama, Y. Relationship between balance function and falls among the frail elderly persons (in Japanese). Sogo-riha 2000; 28: 961–966.Google Scholar
9.Gupta, A, Ledin, T, Larsen, LE, Lennmarken, C, Odkvist, LM. Computerized dynamic posturography. A new method for the evaluation of postural stability following anaesthesia. Br J Anaesth 1991; 66: 667–672.Google Scholar
10.Makker, R, Bailey, P, Royston, R, Kulinskaya, E. Computerized dynamic posturography to assess recovery comparing general anaesthesia with sedation and local anaesthesia for day case nasal surgery. Anaesthesia 2001; 56: 1090–1115.Google Scholar
11.Fujisawa, T, Takuma, S, Koseki, H, Kimura, K, Fukushima, K. Recovery of intentional dynamic balance function after intravenous sedation with midazolam in young and elderly subjects. Eur J Anaesthesiol 2006; 23: 422–425.CrossRefGoogle Scholar
12.Custon, TM, Gray, SL, Hughes, MA, Carson, SW, Hanlon, JT. Effect of a single dose of diazepam on balance measures in old people. J Am Geriatr Soc 1997; 45: 435–440.Google Scholar
13.Schonle, PW, Isenberg, C, Crozier, TA, Dressler, D, Machetanz, J, Conrad, B. Changes of transcranially evoked motor responses in man by midazolam, a short acting benzodiazepine. Neurosci Lett 1989; 101: 321–324.Google Scholar
14.van Dongen, ER, ter Beek, HT, Aarts, LP et al. . The effect of two low-dose propofol infusions on the relationship between six-pulse transcranial electrical stimulation and the evoked lower extremity muscle response. Acta Anaesthesiol Scand 2000; 44: 799–803.CrossRefGoogle ScholarPubMed
15.Nathan, N, Tabaraud, F, Lacroix, F et al. . Influence of propofol concentrations on multipulse transcranial motor evoked potentials. Br J Anaesth 2003; 91: 493–497.Google Scholar
16.Liu, J, Singh, H, White, PF. Electroencephalogram Bispectral analysis predicts the depth of midazolam-induced sedation. Anesthesiology 1996; 84: 64–69.CrossRefGoogle ScholarPubMed
17.Singh, H. Bispectral Index (BIS) monitoring during propofol-induced sedation and anaesthesia. Eur J Anaesthesiol 1999; 16: 31–36.CrossRefGoogle ScholarPubMed
18.Persson, F, Kristensen, BB, Lund, C, Kehlet, H. Postural stability after inguinal herniorrhaphy under local infiltration anaesthesia. Eur J Surg 2001; 167: 449–452.Google Scholar
19.Liston, RAL, Brouwer, BJ. Reliability and validity of measures obtained from stroke patients using the Balance Master. Arch Phys Med Rehabil 1996; 77: 425–430.Google Scholar
20.Commissaris, DA, Nieuwenhuijzen, PH, Overeem, S, de Vos, A, Duysens, JE, Bloem, BR. Dynamic posturography using a new movable multidirectional platform driven by gravity. J Neurosci Methods 2002; 113: 73–84.Google Scholar
21.El-Kashlan, HK, Shepard, NT, Asher, AM, Smith-Wheelock, MS, Telian, SA. Evaluation of clinical measures of equilibrium. Laryngoscope 1998; 108: 311–319.CrossRefGoogle ScholarPubMed
22.Mathias, S, Nayak, USL, Isaacs, B. Balance in the elderly patients: The ‘Get-up and Go’ test. Arch Phys Med Rehabil 1986; 67: 387–389.Google Scholar
23.Padsiadlo, D, Richardson, S. The timed ‘Up & Go’: A test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39: 142–148.Google Scholar
24.Shumway-Cook, A, Brauer, S, Woollacott, M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go test. Phys Ther 2000; 80: 896–903.Google Scholar
25.Dite, W, Temple, VA. A clinical test of stepping and change of direction to identify multiple falling older adults. Arch Phys Med Rehabil 2002; 83: 1566–1571.CrossRefGoogle ScholarPubMed
26.Chiu, AY, Au-Yeung, SS, Lo, SK. A comparison of four functional tests in discriminating fallers from non-fallers in older people. Disabil Rehabil 2003; 25: 445–450.Google Scholar
27.Lin, MR, Hwang, HF, Hu, MH, Wu, HD, Wang, YN, Huang, FC. Psychometric comparisons of the timed up and go, one-leg stand, functional reach, and Tinetti balance measures in community-dwelling older people. J Am Geriatr Soc 2004; 52: 1343–1348.Google Scholar
28.Dettmann, MA, Linder, MT, Sepic, SB. Relationships among walking performance, postural stability, and functional assessments of the hemiplegic patient. Amer J Phys Med 1987; 66: 77–90.Google Scholar
29.Imms, FJ, Edholm, OG. Studies of gait and mobility in the elderly. Age Ageing 1981; 10: 147–156.Google Scholar