Comparison of remifentanil with dexmedetomidine for monitored anaesthesia care in elderly patients during vertebroplasty and kyphoplasty

Abstract

Objectives This clinical trial is registered at ClinicalTrials.gov. (NCT02476981)This randomized, prospective double-blind study compared remifentanil with dexmedetomidine for monitored anaesthesia care during minimally invasive corrections of vertebral compression fractures (vertebroplasty or kyphoplasty).MethodsPatients > 65 years of age with American Society of Anesthesiologists (ASA) classification I–III, scheduled for vertebroplasty or kyphoplasty under monitored anaesthesia care, received remifentanil (i.v. infusion 1–5 µg/kg/h) or dexmedetomidine (loading dose 0.3–0.4 µg/kg followed by i.v. infusion 0.2–1 µg/kg/h) to maintain observer's assessment of alertness/sedation (OAA/S) scale <4 during the procedure.ResultsThere were no statistically significant differences in demographic data between the remifentanil (n = 37) and dexmedetomidine groups (n = 38). Patients on dexmedetomidine experienced lower mean arterial pressure (MAP) and heart rate (HR), and higher SpO2 values, than patients on remifentanil. Compared with dexmedetomidine, remifentanil produced more respiratory depression, oxygen desaturation, and reduced the need for additional intraoperative opioids. There were no significant between-group differences in terms of recovery time, investigators’ satisfaction scores, or patients’ overall pain experiences.ConclusionsDuring monitored anaesthesia care, dexmedetomidine provides less respiratory depression, lower MAP and HR, but also less analgesic effect than remifentanil in elderly patients undergoing vertebroplasty or kyphoplasty.

Dexmedetomidine versus propofol-opioid for sedation in transcatheter aortic valve implantation patients: a retrospective analysis of periprocedural gas exchange and hemodynamic support

“…For example, patients randomized to a DEX/ ketamine combination for endoscopic retrograde cholangiopancreatography experienced significantly fewer sedation-related adverse events, including desaturation and hypotension, compared with those in the propofol/opioid group, 32 and similar results have been reported in other settings. 33,34 Sedation-related hemodynamic instability in TAVI procedures is a difficult endpoint to determine, as procedural steps can directly cause hemodynamic instability. Aortic regurgitation due to balloon valvuloplasty, implantation of balloon-expandable valves under rapid ventricular pacing, and temporary obstruction of the left ventricular outflow tract during implantation of self-expanding valves either directly cause hypotension or may precipitate subsequent hemodynamic instability.…”

The efficacy of dexmedetomidine-remifentanil versus dexmedetomidine-propofol in children undergoing flexible bronchoscopy

“…[7] The most commonly used anesthetic agents include midazolam, propofol, etomidate, opioids, and inhalation anesthetics, however, each of these drugs has its limitations. [8–10] . Combination of these drugs can result in severe respiratory depression, which is the most common complication and the reason of flexible bronchoscopy failure.…”

Ultrasound-guided thoracic paravertebral block for percutaneous kyphoplasty: A prospective non-randomized comparative study

“…Sedative analgesia with opioids and benzodiazepines, which controls the patient's anxiety and pain without the need for an intervention to maintain respiratory and cardiac function, may be appropriate for elderly patients with increased general anaesthesia risk. However, the use of sedatives in elderly patients in the prone position may carry the potential for opioid-induced respiratory depression [4,14]. Although subarachnoid and thoracic epidural anesthesia may be effective for PKP, these anesthesia methods are often associated with a high failure rate and complications such as epidural hematoma, infection, hypotension and urinary retention [3,15].…”