Post-traumatic stress and awareness in patient with traumatic lower limb surgery by neuraxial anesthesia: A randomized clinical trial

Background: Anesthesia decreases brain cognitive function, memory and pain, and also leads to the loss of consciousness. In this study, midazolam and propofol-sedated trauma patients undergoing lower limb surgery were evaluated for stress levels after neuraxial anesthesia.Materials and methods: This double-blind randomized clinical trial was conducted on patients with lower ex-tremity fractures due to trauma, who were candidates of elective lower extremity orthopedic surgery. Patients were randomly divided into two groups of propofol-sedated patients (n=110) and midazolam-sedated patients (n=110) after neuraxial anesthesia. Then, all patients underwent spinal anesthesia using 3 ml of 0.5% bupiv-acaine (3 mg/kg). Propofol (25-75 & mu;g/kg/minute) was infused, and 1-2 mg of midazolam was injected PRN until patients reached the score of 3 on the Modified Observers' Assessment of Alertness/ Sedation Scale (MOAA/S). Results: Preoperative sedation/alertness scores of patients in the two groups did not differ significantly from one another. Penetrating memories in the midazolam group was higher than the propofol group (P<0.05). Per-sonal relationship problem was more significant in the midazolam group than the propofol group (P<0.05). In-ability in controlling emotional feelings was higher in the midazolam group compared to the propofol group (P<0.001).Conclusion: Our findings indicated that a sub-hypnotic dose of propofol provided a superior sedation and am-nesia compared to midazolam. Aspects of stress, including penetrating memories, personal relationship prob-lems, inability to control emotional feelings, and lack of depression during spinal anesthesia were better man-aged by propofol compared to midazolam.