Şule ARICAN, Şeref OTELCİOGLU, Ruhiye REİSLİ, Gamze SARKILAR

Remifentanil infusion versus propofol and remifentanil patient controlled sedation/analgesia for moderate sedation during interventional radiological procedures: A prospective randomized trial

Aim: The use of intravenous sedation and analgesia during interventional radiological procedures is increasing. Sedation and analgesia should minimize patients’ negative psychological reactions caused by fears and anxiety. Also they should relieve pain and provide patients a safe and comfortable environment.The aim of this study was to compare the efficacy and safety of two drugs and methods used for moderate sedation during radiological procedures.Material and Methods: Sixty patients, with American Society of Anesthesiologists scores (ASA) I-II-III, undergoing interventional radiology procedures were included in this study. The patients were administered remifentanil bolus (0.2 µg.kg-1) followed by remifentanil infusion (0.05 µg.kg-1.min-1) in Group R, 2.5mL loading dose (25 mg propofol–25 µg remifentanil) and a 1mL bolus dose (10 mg propofol–10 µg remifentanil) via patient-controlled analgesia/sedation (PCAS) device in Group PR. All the patients’sedation levels were assessed with the Ramsey Sedation Scale (RSS), pain levels were assessed with Visual Analog Scale (VAS). Their recoveries were assessed with the modified Aldrete score (MAS) at 5 min intervals.Results: Although a significant difference was noted between the groups for RSS values at 5, 10, 20, 25, and 30th minutes during the procedure (P 0.05).Conclusion: Both propofol–remifentanil PCAS and remifentanil infusion provide sufficient moderate sedation.

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Srinivasa V, Kodali BS. Capnometry in the spontaneously breathing patient. Curr Opin Anaesthesiol 2004;17(6):517– 20.
Mueller PR, Biswal S, Halpern EF, Kaufman JA, Lee MJ. Interventional radiologic procedures: patient anxiety, perception of pain, understanding of procedure, and satisfaction with medication-a prospective study. Radiology 2000;215(3):684–8.
Patatas K, Koukkoulli A. The use of sedation in the radiology department. Clin Radiol 2009;6487):655–63.
Olsen JW, Borger RL, Doshi SK. Moderate sedation: what radiologists need to know. AJR Am J Roentgenol 2013;201(59:941–6.
Mandel JE, Lichtenstein GR, Metz DC, Ginsberg GG, Kochman ML. A prospective, randomized, comparative trial evaluating respiratory depression during patient-controlled versus anesthesiologist-administered propofol-remifentanil sedation for elective colonoscopy. Gastrointest Endosc 2010;72(1):112–3.
Eberl S, Polderman JA, Preckel B, Kalkman CJ, Fockens P, Hollmann MW. Is ‘really conscious’ sedation with solely an opioid an alternative to every day used sedation regimes for colonoscopies in a teaching hospital? Midazolam/fentanyl, propofol/alfentanil, or alfentanil only for colonoscopy: a randomized trial. Tech Coloproctol 2014;18(8):745–52.
Shabanie A. Conscious sedation for interventional procedures: a practical guide. Tech Vasc Interv Radiol 2006;9(2):84–8.
Tuite C, Rosenberg EJ. Sedation and analgesia in interventional radiology. Semin Intervent Radiol 2005;22(2):114–20.
Arepally A, Oechsle D, Kirkwood S, Savader SJ. Safety of conscious sedation in interventional radiology. Cardiovasc Intervent Radiol 2001;24(3):185-90.
Mazanikov M, Udd M, Kylanpaaa L, Mustonen H, Lindström O, Farkkila M, et al. Patient-controlled sedation with propofol and remifentanil for ERCP: a randomized, controlled study. Gastrointest Endosc 2011;73(29:260–6
Joo HS, Perks WJ, Kataoka MT, Errett L, Pace K, Honey RJ. A comparison of patient-controlled sedation using either remifentanil or remifentanil-propofol for shock wave lithotripsy. Anesth Analg 2001;93(5):1227-32.
Akcaboy ZN, Akcaboy EY, Albayrak D, Altinoren B, Dikmen B, Gogus N. Can remifentanil be a beter choice than propofol for colonoscopy during monitored anesthesia care? Acta Anaesthesiol Scand 2006;50(6):736-1.
Park NS, Bae JI, Park AW, Won JH, Lee HS. Safety and effectiveness of analgesia with remifentanil for percutaneous transhepatic biliary drainage. AJR Am J Roentgenol 2009;192(5):1430-3.
Parashchanka A, Schelfout S, Coppens M. Role of novel drugs in sedation outside the operating room: dexmedetomidine, ketamine and remifentanil. Curr Opin Anaesthesiol 2014;27(4):442-7.
Johnson S. Sedation and analgesia in the performance of interventional procedures. Semin Intervent Radiol 2010;27(4):368-73.
McGrath B, Chung F. Postoperative recovery and discharge. Anesthesiolgy Clin N Am 2003;21(2):367-86.
Agostoni M, Fanti L, Arcidiacono PG, Gemma E, G Strini Torri G, Testoni PA. Midazolam and pethidine versus propofol and fentanyl patient controlled sedation/analgesia for upper gastrointestinal tract ultrasound endoscopy: a prospective randomized controlled trial. Dig Liver Dis 2007;39(11):1024-9.
Moran TC, Kaye AD, Mai AH, Bok LR. Sedation, analgesia, and local anesthesia: a review for general and interventional radiologists. Radiographics 2013;33(2):47-60.
Karaman S. Akarsu T. Fırat V. Epidural anestezide bilinçli sedasyon; remifentanyl ve propofol karşılaştırması. Türk Anesteziyoloji ve Reanimasyon Derneği Dergisi. 2005;33(2):313-20.
Haytural C. Aydınlı B. Demir B. Bozkurt E. Parlak E. Dişibeyaz S. et al. Comparison of Propofol, Propofol-Remifentanil, and Propofol-Fentanyl Administrations with Each Other Used for the Sedation of Patients to Undergo ERCP. Biomed Res Int. 2015;465465.
McQuaid KR, Laine L. A systematic review and metaanalysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures. Gastrointest Endosc 2008;67(6):910–23.
American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by nonanesthesiologists. Anesthesiology 2002;96(4):1004–17.