Sedation-analgesia in elective colonoscopy: propofol-fentanyl versus propofol-alfentanil. Braz J Anesthesiol. 2013;63:352-357. [PMID: 24565243 DOI: 10.1016/j.bjane.2012.07.007]

Effects of intravenous lidocaine on alfentanil consumption during procedural sedation for colonoscopy in patients with inflammatory bowel disease: a randomized controlled trial

Background: Procedural sedation and analgesia (PSA) is used during colonoscopy to facilitate the procedure and relieve patient’s discomfort. The foremost risk of PSA is respiratory depression. Lidocaine could be a promising additional analgesic in IBD patients to minimise side effects of PSA. Objective: Our primary objective was to investigate whether i.v. lidocaine reduces the amount of alfentanil used during PSA in IBD patients. Additionally, we investigated whether lidocaine reduces cardiorespiratory incidents and the amount of propofol required during the procedure. Design: A randomized, double-blind, placebo controlled study. Setting: Single-center study from November 2016 to December 2018. Methods: Seventy-six patients with IBD, ASA 1 or 2, between 18 and 65 years, scheduled for colonoscopy with PSA were included. Exclusion criteria were: pregnancy, emergency colonoscopy, allergies for study medication, rhythm disorders, cardiomyopathy, BMI < 18 kg m -2 , BMI > 35 kg m -2 , obstructive sleep apnea syndrome and uncontrolled hypertension. Patients received lidocaine 1.5 mg kg -1 followed by a continuous infusion of 2 mg kg -1 h -1 (intervention group, n=38) or 0.9% saline in equivalent volumes (control group, n=38) during colonoscopy. Main outcome measures: Amount of alfentanil and propofol used during the interventional procedure. Cardiorespiratory events as defined in methods during the colonoscopy. Results: There was a not statistically significant reduction in the use of alfentanil [327 µg (95%CI=-31-505, p=0.082)] and propofol [39 mg (95%CI=-5-83, p=0.083)] in the lidocaine group compared with the control group. Ten patients (26%) in the control group and 8 patients in the lidocaine group (21%) experienced a period of hypoxia (p=0.788). In both groups, no periods of hypotension were noted. Conclusion: Our investigation has shown a trend for reduced alfentanil and propofol consumption in patients receiving lidocaine during colonoscopy under sedation. The differences were not statistically significant. Lidocaine did not reduce the incidence of cardiorespiratory events.

Patient-controlled analgesia and sedation with remifentanil-propofol mixture for colonoscopy

AIM: To evaluate the feasibility and efficacy of patient-controlled analgesia and sedation (PCAS) with remifentanil-propofol mixture for colonoscopy.

METHODS: Eighty patients were randomly allocated into either a PCAS group or a total intravenous anesthesia (TIVA) group. In the PCAS group, remifentanil-propofol mixture was pumped at 0.01 mL/(kg•min) after an initial bolus of 3 mL of the mixture (1 mL mixture containing propofol 3 mg and remifentanil 10 μg). The amount of each bolus delivered was 1 mL and the lockout time was 1 min. In the TIVA group, patients received fentanyl 1 μg/kg, midazolam 0.02 mg/kg and propofol (dosage titrated). Cardiorespiratory parameters and auditory evoked response index (AAI) were continuously monitored during the procedure. Recovery from anesthesia was assessed with the Aldrete scale and the Observer's Assessment of Alertness/Sedation Scale. Visual analogue scale (VAS) was used to assess the satisfaction of patients and endoscopists.

RESULTS: No statistical differences were observed in the VAS score of patients (9.58 vs 9.50) or satisfaction of endoscopists (9.43 vs 9.30) between the two groups. A significant decline in mean arterial blood pressure and AAI was recorded in the TIVA group (P < 0.05). Recovery time was significantly shorter in the PCAS group (P < 0.01).

CONCLUSION: PCAS with remifentanil-propofol mixture provides better hemodynamic stability, lighter sedation and faster recovery compared with TIVA.