Recovery from propofol anaesthesia supplemented with remifentanil

Abstract

We have examined the effects on recovery end-points of supplementation of a propofol-based anaesthetic with remifentanil. After induction of anaesthesia with propofol and remifentanil 1.0 microg kg(-1), 15 patients each were randomly allocated to target plasma propofol concentrations of 2, 3, 4 or 5 microg ml(-1) for maintenance of anaesthesia. Remifentanil was administered by infusion for supplementation in doses required for maintenance of adequate anaesthesia. All patients received 50% nitrous oxide in oxygen and ventilation was controlled. The total amount of drugs used and times to different recovery end-points were recorded. Cognitive function was also assessed using a Mini-Mental State questionnaire. The median dose of remifentanil for maintenance of adequate anaesthesia (excluding the initial bolus dose) in the four groups was 0.21, 0.15, 0.11 and 0.13 microg kg(-1) min(-1) respectively (P=0.0026). The median times to eye opening and orientation were shortest in the 2 microg ml(-1) group [6.0 and 6.5 min, 8.5 and 10.8 min, 13.4 and 15.8 min, and 14.2 and 19.5 min respectively in the propofol 2, 3, 4, and 5 microg ml(-1) groups respectively (P<0.001)]. The times to discharge from the recovery ward and the Mini-Mental State scores were not significantly different.

Remifentanil used to supplement propofol does not improve quality of sedation during spontaneous respiration

“…This is the first study to assess the effect of adding remifentanil to propofol on recovery parameters in spontaneous ventilation anesthesia. O'Hare et al 15 demonstrated shorter recovery times when maintenance of anesthesia is changed from using a higher dose of propofol with a lower dose of remifentanil to a regimen with a lower dose of propofol and a higher dose of remifentanil. However, in that study ventilation was controlled, so these data are not comparable with the data presented herein.…”

Intravenous Sedation for Pediatric Gastrointestinal Endoscopy in a Developing Country

“…In our endoscopy center, propofol is also administered by an anesthesiologist or nurse anesthetist. Propofol provides equal or better control and more rapid recovery when compared with midazolam for sedation (O'Hare et al, 2001). Initial intravenous bolus dose of propofol is 1.0 mg/kg and is followed by 0.5 mg/kg, and the repeated dose is needed.…”

Anesthesia and sedation in pediatric gastrointestinal endoscopic procedures: A review

“…Remifentanil has been shown to have propofolsaving effect, thus allowing a lower dose of propofol to be used for the maintenance of anesthesia [20] . A combination of remifentanil and propofol is considered safe, effective and acceptable for sedation in children under going gastrointestinal endoscopy [21] .…”

“…The authors recommend this combination for sedation in children in a hospital setting in presence of an anesthesiologist. When compared with midazolam for sedation, propofol provides equal or better control and more rapid recovery [20] .…”