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The effect of audiovisual distraction on patient-controlled sedation under spinal anesthesia: a prospective, randomized trial

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Audiovisual distraction (AVD) has been used to augment or replace procedural sedation. We investigated whether AVD in patients having total hip (THA) or total knee arthroplasty (TKA) under spinal anesthesia would reduce self-administered propofol consumption during surgery. 50 participants were randomized equally into a patient-controlled sedation (PCS) group or AVD group. All participants were given a spinal block and a propofol PCS device prior to surgery. In addition, Group AVD participants selected and watched a movie or documentary film on a tablet device with noise-cancelling headphones during surgery. The primary outcome of this study was total propofol consumption standardized as mcg/kg/min. Secondary outcomes evaluated increased supplemental oxygen use, rescue airway interventions, hypotension, disruptive movement events during surgery, sedation, and satisfaction with anesthesia scores. Historical clinician-controlled propofol usage at our institution over the previous 2 years were recorded. There was no significant difference in median propofol consumption between Groups PCS and AVD, 8.4 mcg/kg/min (1.6–18.9) vs 4 mcg/kg/min (0–9) (P = 0.29), respectively. Historical clinician-controlled usage of propofol demonstrated a median of 39.3 mcg/kg/min (29.2–51.2). There were few differences in the secondary outcome measures. The use of AVD did not reduce patient-controlled propofol consumption in patients having a THA or TKA surgery under spinal anesthesia.

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The authors would like to recognize University of Utah anesthesiology residents Drs. Landon Woolf, Heather Henry, Jared Hicks and Kevin Conrad for their contributions during the data collection phase of this study. We would also like to acknowledge Nathan Pace, MD, MStat and Angela Presson, PhD for their assistance with the statistical analysis of our data. The Iowa Satisfaction with Anesthesia Scale is copyrighted by Franklin Dexter and the University of Iowa Research Foundation. This study was funded by the Departments of Anesthesiology and Orthopaedics at the University of Utah School of Medicine, Salt Lake City, UT.


Funding for this study was provided entirely by the Department of Anesthesiology and the Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.

Author information

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by AWM, MJB, MG, EWP, LN, CMA, ARS, JG, KBJ. The first draft of the manuscript was written by AW Meier and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Correspondence to Adam W. Meier.

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The authors declare no financial or personal conflicts of interest.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the University of Utah Institutional Review Board (IRB102391) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Written informed consent was obtained from all study participants prior to participating in the study.

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Meier, A.W., Buys, M.J., Gill, M. et al. The effect of audiovisual distraction on patient-controlled sedation under spinal anesthesia: a prospective, randomized trial. J Clin Monit Comput (2020). https://doi.org/10.1007/s10877-020-00478-y

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