OC1.07.5 Sedation for Eus: A Randomised Prospective Trial Comparing Low-Dose Propofol+ Remifentanil, Midazolam+meperidine and Standard-Dose of Propofol

Matteo, FM Di; Réa, Rosângela Roginski; Pandolfi, Marcela; Martino, Marco; Carassiti, Massimiliano; Agrò, F.; Costamagna, Guido; Gabbrielli, Alice

doi:10.1016/s1590-8658(08)60059-6

Digestive and Liver Disease

2008

DOI: 10.1016/s1590-8658(08)60059-6

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OC1.07.5 Sedation for Eus: A Randomised Prospective Trial Comparing Low-Dose Propofol+ Remifentanil, Midazolam+meperidine and Standard-Dose of Propofol

FM Di Matteo¹,

Rosângela Roginski Réa²,

Marcela Pandolfi³

et al.

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“…The combination of remifentanil and propofol for deep sedation decreases the incidents of movement, cough, and hiccup during colonoscopy [6]. A few studies have mentioned the impact of remifentanil during advanced gastrointestinal endoscopy [7][8][9][10][11][12][13].…”

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Efficacy and safety of remifentanil for endoscopic ultrasound-guided tissue acquisition: a single center retrospective study

et al. 2022

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Background Remifentanil is a rapid onset and rapid recovery opioid. The combination of remifentanil and propofol for deep sedation decreases the incidents of movement, cough, and hiccup. We evaluated the efficacy and safety of remifentanil during endoscopic ultrasound-guided tissue acquisition. Methods We retrospectively reviewed patients in whom endoscopic ultrasound-guided tissue acquisition was performed for solid mass lesions of the upper gastrointestinal tract and adjacent organs. All patients were premedicated with midazolam (2 mg), and target-controlled infusion of propofol, opioid, and Bispectral Index (BIS) monitoring were administered as necessary to maintain moderate-to-deep sedation. The opioids used were a bolus of alfentanil or remifentanil infusion. The discharge time, consumption of propofol and opioid, adverse events, diagnostic accuracy, and sensitivity and specificity for malignancy, were compared. Results Tissue acquisition was achieved in 123 patients (alfentanil group, n = 64; remifentanil group, n = 59). The discharge time of the remifentanil group (16.5 ± 3.2 min) was significantly shorter than that of the alfentanil group (19.0 ± 4.9 min, P = 0.001). The consumption of propofol, adverse events, diagnostic accuracy, sensitivity, and specificity for malignancy in the alfentanil group were not significantly different from those in the remifentanil group. Conclusions Use of alfentanil or remifentanil for target-controlled infusion of propofol–BIS monitoring can provide good sedative and diagnostic quality for endoscopic ultrasound-guided tissue acquisition. However, remifentanil resulted in faster recovery than alfentanil.

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confidence: 99%

Efficacy and safety of remifentanil for endoscopic ultrasound-guided tissue acquisition: a single center retrospective study

et al. 2022

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Feasibility and safety of deep sedation with propofol and remifentanil in spontaneous breathing during endoscopic retrograde cholangiopancreatography: an observational prospective study

De Vico,

Biasucci,

Aversano

et al. 2023

BMC Anesthesiol

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Background Endoscopic retrograde cholangiopancreatography (ERCP) is an interventional procedure that requires deep sedation or general anaesthesia. The purpose of this prospective observational study was to assess the feasibility and safety of deep sedation in ERCP to maintain spontaneous breathing. Methods This is a single-centre observational prospective cohort study conducted in a tertiary referral university hospital. All consecutive patients who needed sedation or general anaesthesia for ERCP were included from January 2021 to June 2021. Deep sedation was achieved and maintained by continuous infusion of an association of propofol and remifentanil. The primary endpoint was to assess the prevalence of major anaesthesia-related complications, such as arrhythmias, hypotension, gas exchange dysfunction, and vomiting (safety endpoint). Secondary endpoints were: (a) to assess the prevalence of signs of an insufficient level of sedation, such as movement, cough, and hiccups (feasibility endpoint): (b) time needed to achieve the target level of sedation and for recovery from anaesthesia. In order to do so we collect the following parameters: peripheral oxygen saturation, fraction of inspired oxygen, noninvasive systemic blood pressure, heart rate, number of breaths per minute, neurological functions with the use of the bispectral index to determine depth of anaesthesia, and partially exhaustive CO2 end pressure to continuously assess the ventilatory status. The collected data were analysed by several tests: Shapiro-Wilk, Student’s t, Tuckey post-hoc, Wilcoxon rank-sum and Kruskall-Wallis ran. Statistical analysis was performed using Stata/BE 17.0 (StataCorp LLC). Results 114 patients were enroled. Eight patients were excluded because they did not meet the inclusion criteria. We found that all patients were hemodynamically stable: intraoperative mean systolic blood pressure was 139,23 mmHg, mean arterial pressure was on average 106,66 mmHg, mean heart rate was 74,471 bpm. The mean time to achieve the target level of sedation was 63 s, while the mean time for the awakening after having stopped drug infusion was 92 s. Conclusions During ERCP, deep sedation and analgesia using the association of propofol and remifentanil and maintaining spontaneous breathing are safe and feasible, allowing for a safe and quick recovery from anaesthesia.

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OC1.07.5 Sedation for Eus: A Randomised Prospective Trial Comparing Low-Dose Propofol+ Remifentanil, Midazolam+meperidine and Standard-Dose of Propofol

Cited by 2 publications

References 0 publications

Efficacy and safety of remifentanil for endoscopic ultrasound-guided tissue acquisition: a single center retrospective study

Efficacy and safety of remifentanil for endoscopic ultrasound-guided tissue acquisition: a single center retrospective study

Feasibility and safety of deep sedation with propofol and remifentanil in spontaneous breathing during endoscopic retrograde cholangiopancreatography: an observational prospective study

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