Conscious analgesia/sedation with remifentanil and propofol versus total intravenous anesthesia with fentanyl, midazolam, and propofol for outpatient colonoscopy

Apr 24, 2003Gastrointestinal endoscopy

Pain relief and sedation with remifentanil and propofol versus full intravenous anesthesia with fentanyl, midazolam, and propofol for outpatient colonoscopy

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Abstract

All patients in the total intravenous anesthesia (TIVA) group reported a painless colonoscopy (NRS score 0).

The average pain intensity score in the sedation group was 0.4 (0.8).
The TIVA group achieved a significantly longer time to reach the maximum recovery score compared to the sedation group, with differences of -6.9 (4.0) versus 25.7 (8.4) minutes (p < 0.001).
Significant changes in mean arterial pressure and heart rate were observed in the TIVA group (p < 0.05).
Combined use of remifentanil and propofol provided sufficient pain relief during colonoscopy.
Patients receiving sedation were discharged approximately 15 minutes after the procedure, indicating rapid recovery.

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BACKGROUND: This study tested the hypothesis that, for colonoscopy, analgesia/sedation with remifentanil and propofol might be more effective compared with anesthesia by intravenous administration of midazolam, fentanyl, and propofol.

METHODS: In a prospective, randomized trial, 100 adult patients received either conscious analgesia/sedation (Sedation group) or total intravenous anesthesia (TIVA group). Analgesia/sedation was achieved by infusion of remifentanil (0.20 to 0.25 microg/kg/min) and propofol in titrated doses. TIVA was induced by intravenous administration of fentanyl (2 microg/kg), midazolam (0.05 mg/kg) and propofol (dosage titrated). Cardiorespiratory parameters and bispectral index were monitored and recorded. The quality of the analgesia was assessed with a Numerical Pain Rating Scale (NRS); recovery level and return of psychomotor efficiency were evaluated with, respectively, the Aldrete scale and a Modified Post Anesthesia Discharge Scoring (MPADS) system.

RESULTS: Both groups of 50 patients were comparable with respect to demographic data, initial parameters, and duration of colonoscopy. All patients in the TIVA group found the colonoscopy painless (NRS score 0). In the Sedation group, the average pain intensity score was 0.4 (0.8). There was a marked difference between the Sedation and TIVA groups with respect to the time from the end of the procedure until the maximum MPADS score was reached: respectively, -6.9 (4.0) versus 25.7 (8.4) minutes (p < 0.001). In the TIVA group, changes in mean arterial pressure and heart rate and signs of respiratory depression were significant (p < 0.05).

CONCLUSIONS: Combined administration of remifentanil and propofol for colonoscopy provides sufficient analgesia, satisfactory hemodynamic stability, minor respiratory depression, and rapid recovery, and allows patients to be discharged approximately 15 minutes after the procedure.

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Conscious analgesia/sedation with remifentanil and propofol versus total intravenous anesthesia with fentanyl, midazolam, and propofol for outpatient colonoscopy

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