[Patient-controlled sedation with propofol for extracorporeal shock wave lithotripsy]

[Remifentanil is an effective alternative to propofol for patient-controlled analgesia during digestive endoscopic procedures]

PURPOSE

Unlike propofol, the self-administration of remifentanil for sedation in gastrointestinal endoscopies has never been evaluated formally. We wanted to compare the efficacy and tolerance of patient self-administration of remifentanil vs propofol during gastrointestinal endoscopy.

METHOD

This prospective randomized, single-blinded study, included 77 patients undergoing gastrointestinal endoscopy. Patients were divided into two groups: group R received remifentanil (5 microg.kg(-1).hr(-1) infusion, 25 microg boli, refractory period of five minutes) and group P received propofol (2 mg.kg(-1).hr(-1) infusion, 0.5 mg.kg(-1) boli, refractory period of ten minutes). A 1 mg.kg(-1) bolus of propofol was administered before the procedure began in cases of marked anxiety. Additional boli of 25 microg of remifentanil or 0.5 mg.kg(-1) of propofol were administered when patients complained during the refractory period. The evaluation targeted analgesic efficacy during the procedure and patient satisfaction. The degree of sedation during the procedure and the occurrence of adverse reactions were analyzed.

RESULTS

Patient satisfaction was high and comparable in both groups, with the number of awake and oriented patients being significantly higher in group R. Hemodynamic and respiratory tolerance was comparable in both groups, despite two episodes of desaturation in group R. The incidence of nausea was significantly higher in group R.

CONCLUSIONS

The self-administration of remifentanil for sedation during gastrointestinal endoscopies is as effective as the self-administration of propofol and can be offered to patients, especially when it is desirable that they remain conscious during the procedure.

Patient-controlled analgesia during SWL treatments

PURPOSE

To identify the factors that influence analgesic consumption during SWL on the Dornier Lithotripter U/50.

PATIENTS AND METHODS

In Group 1 (N = 152), analgesia was induced with propofol 0.8 mg/kg and alfentanil 8 microg/kg. In Groups 2 (N = 78) and 3 (N = 250), the induction dose was reduced by 20%. For all patients, the maintenance dose was propofol 0.25 mg/kg and alfentanil 5 mg/kg administered with a patient-controlled analgesia (PCA) device. Groups 1 and 2 had SWL with the EMSE 220 shockwave emitter, whereas Group 3 was treated with the EMSE F150. Data were collected on treatment, total drug doses, and side effects.

RESULTS

There was no significant difference in PCA dose among the groups, but analgesic consumption was lower in patients treated with the EMSE F150. Except in Group 2, analgesic consumption tended to decrease with age until age <70. The 20% reduction in the induction dose did not cause an increase in PCA usage. Analgesic consumption was higher for kidney than for ureteral stones and was highest for stones in renal pelvis. Consumption was lower for larger stones than for smaller stones and higher for patients receiving more shockwaves. Almost one quarter of patients in Group 1 exhibited transient O2 desaturation during induction, an effect that was less common in the other groups. Ventricular premature beats were detected only during treatment of stones above the ureteropelvic junction.

CONCLUSIONS

Intravenous administration of a combination of alfentanil and propofol via a PCA device is an elegant, reliable, and safe method of analgesosedation for SWL. Patient satisfaction is high, and side effects are uncommon. Faster turnover of patients is possible.