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 23 November 2017

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Remifentanil and propofol versus fentanyl, midazolam, and propofol for colonoscopy

Remifentanil and propofol for colonoscopy provides sufficient analgesia, and allows patients to be discharged soon after the procedure, find researchers in the may issue of Gastrointestinal Endoscopy.

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In this study, researchers tested whether analgesia/sedation with remifentanil and propofol was more effective than anesthesia by IV administration of midazolam, fentanyl, and propofol, for colonoscopy.

The team, from Poland, performed a prospective, randomized trial.

In the study, 100 adult patients received either conscious analgesia/sedation (sedation group) or total intravenous anesthesia (TIVA group). Both groups of patients were comparable with respect to demographic data, initial parameters, and duration of colonoscopy.

In the sedation group the average pain intensity score was 0.4.
Gastrointestinal Endoscopy

The researchers achieved analgesia/sedation by infusion of remifentanil (0.20 to 0.25 µg/kg/min) and propofol in titrated doses.

They induced TIVA by intravenous administration of fentanyl (2 µg/kg), midazolam (0.05 mg/kg) and propofol (dosage titrated).

The team monitored and recorded cardiorespiratory parameters and bispectral index.

They assessed the quality of the analgesia using a Numerical Pain Rating Scale (NRS). In addition, patient's recovery level and psychomotor efficiency were evaluated using the Aldrete scale and a Modified Post Anesthesia Discharge Scoring (MPADS) system.

The research team found that all patients in the TIVA group found the colonoscopy painless (NRS score 0). However, in the sedation group the average pain intensity score was 0.4.

The team identified a marked difference between the 2 groups, with respect to the time from the end of the procedure until the maximum MPADS score was reached. This was -6.9 minutes in the sedation group and 25.7 minutes in the TIVA group.

They also found that, in the TIVA group, changes in mean arterial pressure and heart rate, and signs of respiratory depression were significant.

Dr Robert Rudner's team concluded, "Combined administration of remifentanil and propofol for colonoscopy provides sufficient analgesia…and allows patients to be discharged approximately 15 minutes after the procedure".

Gastrointest Endosc 2003; 57: 657-63
29 April 2003

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