Alfentanil and patient‐controlled propofol sedation – facilitate gynaecological outpatient surgery with increased risk of respiratory events

Abstract

BackgroundWidespread use of patient‐controlled sedation (PCS) demands simplicity and a predictable outcome. We evaluated patients’ safety and ease of use of PCS for gynaecological outpatient procedures.MethodsIn a prospective double‐blind study, 165 patients were randomized to use propofol or propofol with alfentanil as PCS combined with local anaesthetic for pain control. Data on cardiopulmonary function, consciousness, and need for interventions were collected at baseline and every fifth minute. The surgeons’ evaluation of the ease and the duration of the procedure were recorded.ResultsOne hundred and fifty‐five patients used PCS for the entire procedure, 76 patients propofol, and 79 patients propofol/alfentanil. Fifteen procedures in the propofol group were limited or could not be done, compared with four in the propofol/alfentanil group (P = 0.02). The duration of surgery was not affected. The addition of alfentanil affected respiratory function compared with the propofol group: five patients compared with none were manually ventilated (P = 0.03), and two thirds, compared with a quarter, were given supplementary oxygen as their saturation decreased below 90% (P < 0.001). Overall cardiovascular stability was maintained. The propofol group had deeper conscious sedation as measured by the bispectral index (P = 0.03), but all patients could be roused. In the propofol/alfentanil group, five patients became apnoeic and could not be roused.ConclusionsPCS using propofol alone supports patients’ safety, as the addition of alfentanil increased the need for specific interventions to maintain respiratory stability. However, alfentanil increases the feasibility of the procedure, as complementary doses of propofol were not required.

Procedural sedation : Aspects on methods, safety and effectiveness

“…Alfentanil and remifentanil have been considered safe and feasible when combined with propofol in PCS during endoscopy (37,38). The addition of alfentanil increases procedure feasibility but affects respiratory stability (39). A disadvantage of using remifentanil is the increased risk for respiratory depression and nausea compared with alfentanil (40).…”

“…Due to the increased risk for unintended deep sedation when using remifentanil during procedural sedation, patients and procedures need to be carefully selected, and providers must have appropriate knowledge, experience and equipment to handle acute and critical events during the procedure (41). Alfentanil has been used clinically by nonanaesthesia personnel and has the disadvantage of prolonging recovery compared Introduction with remifentanil (37), and it increases respiratory complications compared with propofol alone (39).…”

Patient-controlled sedation in procedural care

“…Studies on PCS have addressed issues of safety [36,37], patients' experiences [36,38,39], programming of pumps, and procedural details [37,40]. However, most studies are rather limited in the number of participants and show limitations in study design.…”

Effects of alfentanil or fentanyl added to propofol for sedation in colonoscopy on cognitive functions: Randomized controlled trial

“…Bispectral index values and vital signs were recorded every minute for the first 10 min after induction of sedation and then at 15,20,25,30,35,40, and 45 min. Pain during the procedure was evaluated using the FPS (0-6), whereas pain after the procedure was evaluated using visual analogue scale (VAS) (0-10) at 5, 15, and 30 min after the procedure.…”