Remifentanil used to supplement propofol does not improve quality of sedation during spontaneous respiration - 24/08/11

Doi : 10.1016/j.jclinane.2003.08.005

Annelies T Moerman, MD ^a,⁎^{*
Staff Anesthesiologist, Department of Anesthesiology} , Michel M.R.F Struys, MD, PhD ^a,^{†
Professor of Anesthesia, Department of Anesthesiology}, Hugo E Vereecke, MD ^a,⁎^{*
Staff Anesthesiologist, Department of Anesthesiology}, Luc L Herregods, MD, PhD ^{†
Professor of Anesthesia, Department of Anesthesiology}, Martine M De Vos, MD, PhD ^b,^{‡
Professor of Gastro-Enterology, Head of the Department of Gastro-Enterology}, Eric P Mortier, MD, DSc ^a,^{§
Professor of Anesthesia, Head of the Department of Anesthesiology}
^a Department of Anesthesiology, Ghent University Hospital, Gent, Belgium
^b Department of Gastro-Enterology, Ghent University Hospital, Gent, Belgium

^*Address correspondence and reprint requests to Dr. Moerman at the Department of Anesthesiology, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium

Abstract

Study objective

To evaluate whether the use of remifentanil to supplement propofol during spontaneous respiration confers any benefits in terms of quality of sedation and recovery, or in terms of reduction in propofol requirements.

Design

Prospective, randomized, double-blind study.

Setting

University hospital.

Patients

50 ambulatory adult ASA physical status I and II patients scheduled for total colonoscopy.

Interventions

Patients were randomized to receive either propofol alone or propofol plus remifentanil 0.1 μg/kg/min, while independently maintaining spontaneous respiration.

Measurements

Cardiovascular and respiratory variables were measured before induction and at 1-minute intervals thereafter. Recovery from anesthesia was assessed using simple verbal commands and the Steward Post Recovery Score. Patient satisfaction was measured with a visual analog scale. Computer simulation was used to calculate the effect-site concentrations of propofol and remifentanil.

Main results

The depressant effects on blood pressure and respiratory function were significantly higher when propofol and remifentanil were combined. Although the addition of remifentanil resulted in a decrease of propofol usage, recovery of anesthesia was faster and patient satisfaction was higher when using propofol alone.