Rudner Robert, Jalowiecki Przemyslaw, Kawecki Piotr, Gonciarz Maciej, Mularczyk Aldona, Petelenz Michal
Department of Anesthesiology and Intensive Therapy, Silesian University School of Medicine, Katowice, Poland.
Gastrointest Endosc. 2003 May;57(6):657-63. doi: 10.1067/mge.2003.207.
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.
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.
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).
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.
本研究检验了以下假设：对于结肠镜检查，与静脉注射咪达唑仑、芬太尼和丙泊酚进行麻醉相比，瑞芬太尼和丙泊酚用于镇痛/镇静可能更有效。
在一项前瞻性随机试验中，100例成年患者接受了清醒镇痛/镇静（镇静组）或全静脉麻醉（TIVA组）。通过输注瑞芬太尼（0.20至0.25微克/千克/分钟）和滴定剂量的丙泊酚实现镇痛/镇静。TIVA通过静脉注射芬太尼（2微克/千克）、咪达唑仑（0.05毫克/千克）和丙泊酚（滴定剂量）诱导。监测并记录心肺参数和脑电双频指数。用数字疼痛评分量表（NRS）评估镇痛质量；分别用Aldrete量表和改良麻醉后出院评分（MPADS）系统评估恢复水平和精神运动效率的恢复情况。
两组各50例患者在人口统计学数据、初始参数和结肠镜检查持续时间方面具有可比性。TIVA组所有患者均感觉结肠镜检查无痛（NRS评分为0）。在镇静组中,平均疼痛强度评分为0.4（0.8）。在从手术结束到达到最大MPADS评分的时间方面，镇静组和TIVA组之间存在显著差异：分别为-6.9（4.0）分钟和25.7（8.4）分钟（p<0.001）。在TIVA组中，平均动脉压、心率变化及呼吸抑制体征均有统计学意义（p<0.05）。
瑞芬太尼和丙泊酚联合用于结肠镜检查可提供充分的镇痛、令人满意的血流动力学稳定性、轻微的呼吸抑制和快速恢复，并使患者在手术后约15分钟即可出院。
