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Propofol versus remifentanil for monitored anaesthesia care during colonoscopy

Published online by Cambridge University Press:  11 July 2005

A. T. Moerman ,
L. A. Foubert ,
L. L. Herregods ,
M. M. R. F. Struys ,
D. J. De Wolf ,
D. A. De Looze ,
M. M. De Vos  and
E. P. Mortier
A. T. Moerman
Affiliation:
Ghent University Hospital, Department of Anaesthesia, Gent, Belgium
L. A. Foubert
Affiliation:
Ghent University Hospital, Department of Anaesthesia, Gent, Belgium
L. L. Herregods
Affiliation:
Ghent University Hospital, Department of Anaesthesia, Gent, Belgium
M. M. R. F. Struys
Affiliation:
Ghent University Hospital, Department of Anaesthesia, Gent, Belgium
D. J. De Wolf
Affiliation:
Ghent University Hospital, Department of Paediatrics, Gent, Belgium
D. A. De Looze
Affiliation:
Ghent University Hospital, Department of Gastro-enterology, Gent, Belgium
M. M. De Vos
Affiliation:
Ghent University Hospital, Department of Gastro-enterology, Gent, Belgium
E. P. Mortier
Affiliation:
Ghent University Hospital, Department of Anaesthesia, Gent, Belgium
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Extract

Summary

Background and objective: We conducted an open, prospective, randomized study to compare the efficacy, safety and recovery characteristics of remifentanil or propofol during monitored anaesthesia care in patients undergoing colonoscopy.

Methods: Forty patients were randomly assigned to receive either propofol (1 mg kg−1 followed by 10 mg kg−1 h−1, n = 20) or remifentanil (0.5 μg kg−1 followed by 0.2 μg kg−1 min−1, n = 20). The infusion rate was subsequently adapted to clinical needs.

Results: In the propofol group, arterial pressure and heart rate decreased significantly from the baseline. These variables remained unchanged in the remifentanil group, but hypoventilation occurred in 55% of patients. Early recovery was delayed in the propofol group (P < 0.002). Recovery of cognitive and psychomotor functions was faster in the remifentanil group. Fifteen minutes after anaesthesia, the Digit Symbol Substitution Test score was 28.6 ± 12.8 versus 36.2 ± 9.4 and the Trieger Dot Test score was 25.6 ± 8.1 versus 18.7 ± 4.1 in the propofol and remifentanil groups, respectively (both P < 0.05). Patient satisfaction, using a visual analogue scale, was higher in the propofol group (96 ± 7 versus 77 ± 21, P < 0.001).

Conclusions: Remifentanil proved efficient in reducing pain during colonoscopy. Emergence times were shorter and the recovery of cognitive function was faster with remifentanil compared with propofol. Remifentanil provided a smoother haemodynamic profile than propofol; however, the frequent occurrence of remifentanil-induced hypoventilation requires the cautious administration of this agent.

Keywords

ANAESTHESIA AND ANALGESIA, conscious sedationANAESTHETICS, INTRAVENOUS, propofol, remifentanilENDOSCOPY, colonoscopy, gastrointestinalPSYCHOMOTOR PERFORMANCE, task performance and analysisSURGICAL PROCEDURES, OPERATIVE, anaesthesia recovery period, postoperative period
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 6 , June 2003 , pp. 461 - 466
Copyright
© 2003 European Society of Anaesthesiology

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