Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-23T01:42:26.474Z Has data issue: false hasContentIssue false
  • English
  • Français

Propofol versus remifentanil for monitored anaesthesia care during colonoscopy

Published online by Cambridge University Press:  11 July 2005

A. T. Moerman ,
L. A. Foubert ,
L. L. Herregods ,
M. M. R. F. Struys ,
D. J. De Wolf ,
D. A. De Looze ,
M. M. De Vos  and
E. P. Mortier
A. T. Moerman
Affiliation:
Ghent University Hospital, Department of Anaesthesia, Gent, Belgium
L. A. Foubert
Affiliation:
Ghent University Hospital, Department of Anaesthesia, Gent, Belgium
L. L. Herregods
Affiliation:
Ghent University Hospital, Department of Anaesthesia, Gent, Belgium
M. M. R. F. Struys
Affiliation:
Ghent University Hospital, Department of Anaesthesia, Gent, Belgium
D. J. De Wolf
Affiliation:
Ghent University Hospital, Department of Paediatrics, Gent, Belgium
D. A. De Looze
Affiliation:
Ghent University Hospital, Department of Gastro-enterology, Gent, Belgium
M. M. De Vos
Affiliation:
Ghent University Hospital, Department of Gastro-enterology, Gent, Belgium
E. P. Mortier
Affiliation:
Ghent University Hospital, Department of Anaesthesia, Gent, Belgium
Get access

Extract

Summary

Background and objective: We conducted an open, prospective, randomized study to compare the efficacy, safety and recovery characteristics of remifentanil or propofol during monitored anaesthesia care in patients undergoing colonoscopy.

Methods: Forty patients were randomly assigned to receive either propofol (1 mg kg−1 followed by 10 mg kg−1 h−1, n = 20) or remifentanil (0.5 μg kg−1 followed by 0.2 μg kg−1 min−1, n = 20). The infusion rate was subsequently adapted to clinical needs.

Results: In the propofol group, arterial pressure and heart rate decreased significantly from the baseline. These variables remained unchanged in the remifentanil group, but hypoventilation occurred in 55% of patients. Early recovery was delayed in the propofol group (P < 0.002). Recovery of cognitive and psychomotor functions was faster in the remifentanil group. Fifteen minutes after anaesthesia, the Digit Symbol Substitution Test score was 28.6 ± 12.8 versus 36.2 ± 9.4 and the Trieger Dot Test score was 25.6 ± 8.1 versus 18.7 ± 4.1 in the propofol and remifentanil groups, respectively (both P < 0.05). Patient satisfaction, using a visual analogue scale, was higher in the propofol group (96 ± 7 versus 77 ± 21, P < 0.001).

Conclusions: Remifentanil proved efficient in reducing pain during colonoscopy. Emergence times were shorter and the recovery of cognitive function was faster with remifentanil compared with propofol. Remifentanil provided a smoother haemodynamic profile than propofol; however, the frequent occurrence of remifentanil-induced hypoventilation requires the cautious administration of this agent.

Keywords

ANAESTHESIA AND ANALGESIA, conscious sedationANAESTHETICS, INTRAVENOUS, propofol, remifentanilENDOSCOPY, colonoscopy, gastrointestinalPSYCHOMOTOR PERFORMANCE, task performance and analysisSURGICAL PROCEDURES, OPERATIVE, anaesthesia recovery period, postoperative period
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 6 , June 2003 , pp. 461 - 466
Copyright
© 2003 European Society of Anaesthesiology

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

Jamieson J. Anesthesia and sedation in the endoscopy suite? (influences and options). Curr Opin Anaesthesiol 1999; 12: 417–423.Google Scholar
Meisel M. Utilisation du Diprivan® pour les endoscopies digestives. Ann Fr Anesth Réanim 1994; 13: 579–584.Google Scholar
Hutchinson RC, Kenny GNC. Sedation for endoscopy. Curr Opin Anaesthesiol 2000; 13: 415–419.Google Scholar
Lezak MD. Neuropsychological Assessment. New York, USA: Oxford University Press, 1983.
Newman MG, Trieger N, Miller JC. Measuring recovery from anaesthesia – a simple test. Anesth Analg 1969; 48: 136–140.Google Scholar
Steward DJ. A simplified scoring system for the postoperative recovery room. Can Anaesth Soc J 1975; 22: 111–113.Google Scholar
Wilhelm W, Biedler A, Hammadeh ME, Fleser R, Grüneß V. Infusionsanalgesie mit Remifentanil. Anaesthesist 1999; 48: 698–704.Google Scholar
Ahmad S, Leavell ME, Fragen RJ, Jenkins W, Roland CL. Remifentanil versus alfentanil as analgesic adjuncts during placement of ophthalmologic nerve blocks. Reg Anesth Pain Med 1999; 24: 331–336.Google Scholar
Holas A, Krafft P, Marcovic M, Quehenberger F. Remifentanil, propofol or both for conscious sedation during eye surgery under regional anaesthesia. Eur J Anaesthesiol 1999; 16: 741–748.Google Scholar
Greilich PE, Virella CD, Rich JM, et al. Remifentanil versus meperidine for monitored anesthesia care: a comparison study in older patients undergoing ambulatory colonoscopy. Anesth Analg 2001; 92: 80–84.Google Scholar
Smith I, Avramov MN, White PF. A comparison of propofol and remifentanil during monitored anesthesia care. J Clin Anesth 1997; 9: 148–154.Google Scholar
Mingus ML, Monk TG, Gold MI, Jenkins W, Roland C and the Remifentanil 3010 Study Group. Remifentanil versus propofol as adjuncts to regional anesthesia. J Clin Anesth 1998; 10: 46–53.Google Scholar
Lauwers MH, Vanlersberghe C, Camu F. Comparison of remifentanil and propofol infusions for sedation during regional anesthesia. Reg Anesth Pain Med 1998; 23: 64–70.Google Scholar
Litman RS. Conscious sedation with remifentanil during painful medical procedures. J Pain Symptom Manage 2000; 19: 468–471.Google Scholar
Smith C, McEwan AI, Jhaveri R, et al. The interaction of fentanyl on the Cp50 of propofol for loss of consciousness and skin incision. Anesthesiology 1994; 81: 820–828.Google Scholar
Babenco HD, Conard PF, Gross JB. The pharmacodynamic effect of a remifentanil bolus on ventilatory control. Anesthesiology 2000; 92: 393–398.Google Scholar
Dubois A, Balatoni E, Peeters JP, Baudoux M. Use of propofol for sedation during gastrointestinal endoscopies. Anaesthesia 1988; 43: 75–80.Google Scholar
Black ML, Hill JL, Zacny JP. Behavioral and physiological effects of remifentanil and alfentanil in healthy volunteers. Anesthesiology 1999; 90: 718–726.Google Scholar
Zacny JP, Lichtor JL, Coalson DW, et al. Subjective and psychomotor effects of subanesthetic doses of propofol in healthy volunteers. Anesthesiology 1992; 76: 696–702.Google Scholar