Comparison of Remifentanil and Fentanyl in Anaesthesia for Elective Cardioversion

Abstract

This prospective, randomized, double-blind study was designed to compare the recovery characteristics of remifentanil and fentanyl in combination with propofol for direct current cardioversion. Patients undergoing elective cardioversion received either intravenous fentanyl 1 µg/kg (n=33) or remifentanil 0.25 µg/kg (n=30) and propofol was titrated to a Ramsay sedation score of 5 by slow intravenous injection. Heart rate, systolic, diastolic and mean blood pressures decreased significantly following sedation in both groups but did not show a significant difference between the groups. Time to answer a question (306±83 vs 383±131s, mean±SD, P=0.014) and time to sit up (412±90 vs 511±126s, P=0.002) were significantly shorter in the remifentanil group compared to the fentanyl group. Side-effects and patient discomfort were similar for both groups. Remifentanil can be used as a suitable supplement to propofol for direct current cardioversion and may provide a faster recovery profile than fentanyl.

Remifentanil for procedural sedation: a systematic review of the literature

“…Most RCTs were found to be at unclear or significant risk of bias. In examining performance bias, only three studies blinded outcome assessors21 26 27 and only one blinded participants and personnel 27. Two studies were at significant risk of attrition bias for not adhering to intention to treat analysis.…”

“…Sedation with remifentanil-propofol was compared with fentanyl-propofol in 63 adult cardioversions27 and in 29 children undergoing 60 procedures 25. In both of these RCTs, there was no difference in procedural success or sedation effectiveness.…”

“…Across all studies, the most frequent adverse event was respiratory depression. One adult RCT reported an insignificant increase in brief apnoea, resolved with verbal stimulation alone, when sedation with remifentanil-propofol was compared with fentanyl-propofol (17% vs 6%, p=0.24) 27. In a trial of 175 children, 20% more respiratory events requiring ‘more than head repositioning’ occurred with remifentanil-methohexital compared with fentanyl-propofol (54% vs 34%, p<0.02).…”

Sedation in the Electrophysiology Laboratory: A Multidisciplinary Review

“…Currently, sedation for EP procedures including EC is most often performed with benzodiazepines, opioids, and propofol . At present there is insufficient evidence to support 1 specific drug regimen over another.…”

“…Currently, sedation for EP procedures including EC is most often performed with benzodiazepines, 38 opioids, 38 and propofol. 39 At present there is insufficient evidence to support 1 specific drug regimen over another. Although benzodiazepines with or without opioids may seem appealing because of practitioner familiarity, ease of titration, and minimal adverse hemodynamic effects, these agents may not be ideal for EC.…”