Remifentanil Conscious Sedation During Regional Anaesthesia for Carotid Endarterectomy: Rationale and Safety

Abstract

remifentanil as a supplement to regional anaesthesia for carotid endarterectomy, provides comfort and analgesia without hampering mental status evaluation.

Continuous infusion of butorphanol combined with intravenous morphine patient-controlled analgesia after total abdominal hysterectomy: a randomized, double-blind controlled trial

“…Such sedation resulted in patients who were cooperative, orientated and calm and who were breathing and coughing adequately and did not delay patient recovery and hospital stay and was in agreement with other studies [25,26]. Conscious sedation is recognized as a clinically applicable strategy to provide comfort and analgesia without hampering mental status evaluation and to help maintain haemodynamic stability during the early postoperative period [27,28]. In addition, conscious sedation could avoid excessive movement from insufficient pain relief and promote postsurgical recovery.…”

Patient comfort during regional anesthesia

“…Krenn et al [29] reported that propofol (1 mg/kg per hour) was comparable with remifentanil (3 lg/kg per minute) for sedation during carotid endarterectomy surgery with regional anesthesia, but it was preferred because it caused less respiratory depression and bradycardia. Remifentanil (0.04 lg/kg per minute) provides comfort and analgesia without hampering mental status evaluation during carotid endarterectomy [30]. Low-dose ketamine (0.5 mg/kg) and midazolam (0.1 mg/kg) together provide analgesia during spinal anesthesia [31].…”

Regional anaesthesia and propofol sedation for carotid endarterectomy

“…It is essential that the depth of sedation can be controlled quickly and easily so that neurological monitoring is not compromised or the advantages of regional anaesthesia are lost 11 . Neuroleptanalgesia with short‐acting opiates has been used successfully during carotid surgery, but in addition to a high incidence of physical reactions, small adjustments to the depth of sedation are difficult 7 . In addition, the patient may remain heavily sedated at the end of the procedure 12,13 .…”

“…Most patients undergoing carotid endarterectomy benefit from sedation, in addition to a regional block and local anaesthetic infiltration 6 . Various agents have been used including short‐acting opiates 7 , benzodiazepines and propofol 8 . Incremental sedative boluses of propofol may produce haemodynamic instability and short periods of apnoea 9 , both of which are undesirable in patients with compromised cerebral circulation.…”