Sedation-Analgesia with Propofol and Remifentanil

Borrat, X.; Valencia, J.; Magrans, Rudys; Giménez-Milà, Marc; Mellado, Ricard; Sendino, Oriol; Perez, Maria; Nunez, Matilde; Jospin, M.; Jensen, Erik Weber; Trocóniz, Iñaki F.; Gambús, Pedro L.

doi:10.1213/ane.0000000000000756

Cited by 22 publications

(11 citation statements)

References 16 publications

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“…Some studies 3 , 9 suggest that endoscopy can be performed without sedation but this is not recommended, as the procedure is very uncomfortable for patients. Both propofol and alfentanil have a rapid onset of action so are useful agents for sedation.…”

Section: Discussionmentioning

confidence: 99%

“… 2 The inability to provide adequate pain control during UGSEMOP can lead to hemodynamic deterioration and esophageal rupture. 3 Provision of appropriate sedation and analgesia reduces stress to the patient and the incidence of complications. 3 Propofol is often used for sedation during UGSEMOP.…”

mentioning

confidence: 99%

“… 3 Provision of appropriate sedation and analgesia reduces stress to the patient and the incidence of complications. 3 Propofol is often used for sedation during UGSEMOP. Alfentanil is a synthetic opioid with a short half-life.…”

mentioning

confidence: 99%

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Alfentanil versus ketamine combined with propofol for sedation during upper gastrointestinal system endoscopy in morbidly obese patients

Kilic

Demiriz

Işıkay

et al. 2016

SMJ

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Objectives:To observe the effects of both propofol/alfentanil and propofol/ketamine on sedation during upper gastrointestinal system endoscopy in morbidly obese patients (UGSEMOP).Methods:In a prospective, double-blinded, randomized clinical study, 52 patients scheduled for UGSEMOP were assigned to either group A (n=26; 10 µg/kg intravenous [IV] alfentanil) or group K (n=26; 0.5 mg/kg IV ketamine). Each patient was administered 0.7 mg/kg propofol for induction. If it was needed, the patients were administered an additional dose of IV propofol. This study was performed in Sehitkamil State Hospital, Gaziantep, Turkey, between January 2014-2015. Total propofol consumption, time to achieve Modified Aldrete Scores (MAS) of 5 and 10 following the procedure, physician and patient satisfaction scores, and instances of side effects, such as bradycardia and hypotension were recorded.Results:Time to onset of sedation and duration of sedation were both significantly shorter in group A. Patients in group A also required less time to achieve an MAS of 5. Total propofol consumption was significantly lower in group A.Conclusion:Both propofol/alfentanil and propofol/ketamine combinations provided appropriate hypnosis and analgesia during UGSEMOP. However, propofol consumption was significantly higher using the propofol/ketamine combination.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Alfentanil versus ketamine combined with propofol for sedation during upper gastrointestinal system endoscopy in morbidly obese patients

Kilic

Demiriz

Işıkay

et al. 2016

SMJ

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“…The calculation of the sample size in this research was based on the literature reports related to remifentanil used in gastroscopy [ 13 – 15 , 32 , 33 ]. The average cases were about 32 to 42 patients in each group.…”

Section: Methodsmentioning

confidence: 99%

“…It has been reported that the administration of intravenous anesthesia can effectively inhibit upper airway reflex, eliminate patients’ anxiety, and improve patients’ comfort during endoscopy, which led to an increase of patients’ willingness to undergo follow-up gastroscopic examination or treatment [ 8 , 9 ]. In previous studies, a number of reports have confirmed the efficacy of general anesthesia in gastrointestinal endoscopy [ 10 – 12 ], and remifentanil proved to be a safe and effective opioid receptor agonist during endoscopy because of its effective inhibition of autonomic nervous reflex in the upper respiratory tract and rare adverse effects on the cardiovascular and respiratory systems [ 13 – 15 ]. However, few reports explore the optimal dose of remifentanil during gastroscopic treatment.…”

Section: Introductionmentioning

confidence: 99%

Effects of small-dose remifentanil combined with index of consciousness monitoring on gastroscopic polypectomy: a prospective, randomized, single-blinded trial

Liu

Yang

et al. 2018

Trials

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BackgroundWith the development of painless diagnosis and treatment, remifentanil, a synthetic opioid agonist, is increasingly used in gastroscopy for its rapid, short-term, and potent analgesic effect. However, the dosage of remifentanil used in endoscopy is unclear. Index of consciousness (IOC) is a new anesthesia depth-monitoring indicator that can be divided into index of consciousness 1 (IOC1) and index of consciousness 2 (IOC2); IOC1 is used for estimating a patient’s sedation state, whereas IOC2 reflects analgesic depth. We hypothesized that combining with IOC1 and IOC2 monitoring may be helpful to identify an optimal remifentanil dosage in gastroscopic polypectomy.MethodsOne hundred twenty patients scheduled for gastroscopic polypectomy were enrolled and were randomly assigned to remifentanil 2 ng/mL (group R2), 4 ng/mL (group R4), or 6 ng/mL (group R6), and 40 cases were in each group. During the anesthesia period, remifentanil was kept at the initial given concentration but propofol was adjusted according to IOC1. The primary outcomes were the dosage of propofol and remifentanil. The secondary outcomes were the variety of IOC1 and IOC2, patients’ awakening time, and peri-operative adverse reactions such as hypotension, hypertension, bradycardia, tachycardia, body movements, hypoxemia, therapy interruption, nausea, vomiting, aspiration, and intra-operative awareness.ResultsWith the increasing dosage of remifentanil, the propofol dosage and patients’ awakening time decreased significantly, the morbidity of hypertension and body movements also declined, but the incidence of hypotension, bradycardia, and hypoxemia rose. In group R2, the value of IOC2 remained above 50 during the treatment. However, IOC2 dropped to below 30 at the beginning of the gastroscopy in group R6, and there was statistical difference in hypoxemia between groups R2 and R6 (P <0.05).ConclusionsWith the help of IOC monitoring, we found that a target concentration of remifentanil 4 ng/mL is comparatively ideal in patients under gastroscopic polypectomy.Trial registrationChinese Clinical Trial Register: ChiCTR-OOD-16009489, on October 19, 2016.

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Teaching TCI with Human Patient Simulators

Heinrichs¹

2017

Total Intravenous Anesthesia and Target Controlled Infusions

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Sedation-Analgesia with Propofol and Remifentanil

Cited by 22 publications

References 16 publications

Alfentanil versus ketamine combined with propofol for sedation during upper gastrointestinal system endoscopy in morbidly obese patients

Alfentanil versus ketamine combined with propofol for sedation during upper gastrointestinal system endoscopy in morbidly obese patients

Effects of small-dose remifentanil combined with index of consciousness monitoring on gastroscopic polypectomy: a prospective, randomized, single-blinded trial

Teaching TCI with Human Patient Simulators

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