Comparison of Sedoanalgesia Versus Ultrasound-Guided Supraclavicular Brachial Plexus Block for the Prevention of the Pain During Endovascular Treatment of Dysfunctional Hemodialysis Fistulas

Gedikoglu, Murat; Andıç, Çağatay; Güzelmansur, İsmail; Eker, H. Evren; Bölgen, Çağatay

doi:10.1007/s00270-019-02293-8

Cited by 9 publications

(11 citation statements)

References 16 publications

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“…In addition, PTA for the dysfunction of hemodialysis fistula is usually performed on an outpatient basis. [ 12 ] Medications should be administered to achieve adequate analgesia, sedation, anxiolysis, and amnesia during the procedures, control of unwanted motor behavior that inhibits the performance of procedures, rapid return of the patient to consciousness, and less risk of adverse events. [ 8 ] The combination of midazolam and remifentanil used in the present study has been proven to fulfill those criteria.…”

Section: Discussionmentioning

confidence: 99%

“…However, BPB was time-consuming and might cause complications such as injury to blood vessels or a nerve, pneumothorax, and local anesthetic systemic toxicity. [ 12 ] Considering an easier and similar way for our daily hospital practice, TCI of remifentanil with intermittent bolus midazolam was used in the present study. Ultimately, in this study, the initial remifentanil Ce of 1.0 or 2.0 ng/mL with midazolam loading dose of 2 to 2.5 mg, which we chose was based on our clinical experience.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, Gedikoglu et al [12] reported that ultrasound-guided supraclavicular brachial plexus block (BPB) had advantages over the sedoanalgesia during PTA. However, BPB was time-consuming and might cause complications such as injury to blood vessels or a nerve, pneumothorax, and local anesthetic systemic toxicity [12] . Considering an easier and similar way for our daily hospital practice, TCI of remifentanil with intermittent bolus midazolam was used in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…However, until now, there are limited data on the use of TCI of remifentanil with midazolam in PTA under MAC. In addition, PTA for the dysfunction of hemodialysis fistula is usually performed on an outpatient basis [12] . Medications should be administered to achieve adequate analgesia, sedation, anxiolysis, and amnesia during the procedures, control of unwanted motor behavior that inhibits the performance of procedures, rapid return of the patient to consciousness, and less risk of adverse events [8] .…”

Section: Discussionmentioning

confidence: 99%

“…However, 14.7% patients under dexmedetomidine-remifentanil anesthesia suffered from hypotensive episodes requiring ephedrine administration. [3] In addition, Gedikoglu et al [12] reported that ultrasoundguided supraclavicular brachial plexus block (BPB) had advantages over the sedoanalgesia during PTA. However, BPB was time-consuming and might cause complications such as injury to blood vessels or a nerve, pneumothorax, and local anesthetic systemic toxicity.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of 2 effect-site concentrations of remifentanil with midazolam during percutaneous transluminal balloon angioplasty under monitored anesthesia care

Lai¹,

Tsai

Huang³

et al. 2021

Medicine

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Background:Until now, target-controlled infusion of remifentanil with midazolam in percutaneous transluminal balloon angioplasty for dysfunctional hemodialysis fistulas has not been described. Here, we investigate 2 effect-site concentrations of remifentanil with intermittent bolus midazolam for percutaneous transluminal balloon angioplasty under monitored anesthesia care.Methods:A prospective, randomized controlled trial including patients who received a percutaneous transluminal balloon angioplasty between March 2019 and March 2021 was conducted. Group 1 and Group 2 were, respectively, administered an initial effect-site concentration of remifentanil of 1.0 and 2.0 ng/mL by a target-controlled infusion pump with Minto model. In both groups, maintenance of the effect-site concentration of remifentanil was adjusted upward and downward by 0.5 ng/mL with intermittent bolus midazolam to keep the Observer's Assessment of Alertness/Sedation scale between 2 and 4, mean arterial pressure and heart rate at baseline levels ± 30%, and patient comfort (remaining moveless). The primary outcome was to determine the appropriate effect-site concentration of remifentanil for the procedure in terms of patient comfort (remaining moveless), hemodynamic conditions, and adverse events. Secondary endpoints included the total dosage of anesthetics and total times of target-controlled infusion pump adjustments.Results:A total of 40 patients in Group 1 and 40 patients in Group 2 were eligible for analysis. Most parameters were insignificantly different between 2 groups, except Group 1 having higher peripheral oxygen saturation, while local anesthetic injection compared with Group 2. In addition, Group 1 patients had less apnea with desaturation (peripheral oxygen saturation < 90%; 0 vs 6, P = .034), less remifentanil consumption (189.65 ± 69.7 vs 243.8 ± 76.1 μg, P = .001), but more intraoperative movements affecting the procedure (14 vs 4; P = .016), total times of target-controlled infusion pump adjustment [2 (1-4) vs 1 (1–2), P < .001] compared with Group 2.Conclusion:In percutaneous transluminal balloon angioplasty for dysfunctional hemodialysis fistulas, target-controlled infusion with remifentanil Minto model target 2.0 ng/mL with 3 to 4 mg midazolam use provided appropriate hemodynamic conditions, sufficient sedation and analgesia, and acceptable apnea with desaturation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%