Application of propofol combined with midazolam sedation in postoperative management of carotid endarterectomy

Objective To evaluate the significance of short-term sedation by propofol combined with midazolam on postoperative management of carotid endarterectomy (CEA). Methods Clinical data about 308 consecutive patients undergoing CEA in our hospital from July 2007 to November 2016 were retrospectively analyzed, and they were all treated with continuous sedation of propofol and midazolam postoperatively for 4-6 hours on the basis of strict blood pressure monitor and control. The Ramsay score was used to assess sedation depth with level 6 indicating achieving sedation goal. Midazolam was discontinuously intravenous-injectd at dosage of 0.04 mg/kg every 45-60 min with a total of 3 times, and propofol was continuously intravenous pumped at 0.5-2.0 mg/(kg·h) for 4-6 hours. Results All patients came around at 3-28 minutes(18.2±5.2) min after withdraw of propofol, and 15-75 minutes later tracheal intubation was successfully extubated. The incidence of bucking with intubation was 10.4% in the process of sedation, and vasoactive pharmaceuticals was administered in 89.3% patients; Patients' heart rate and blood pressure were all controlled in normal range with oxygen saturation of 95%-100%. Incision bleeding was observed in 5 patients, 1 case presented with aphasia and homolateral hemiplegia, 1 case suffered from acute myocardial infarction at 2 days after operation, and 1 case caught pneumonia. No death was documented. Conclusion The present study suggests that short-term sedation by propofol combined with midazalom administration is beneficial to postoperative anesthesia recovery and strict blood pressure control, which can effectively prevent the occurrence of cranial nerve-associated complications.