Fanti Lorella, Agostoni Massimo, Gemma Marco, Gambino Giulia, Facciorusso Antonio, Guslandi Mario, Torri Giorgio, Testoni Pier Alberto
Department of Gastroenterology, Vita-Salute University of Milano, IRCCS H. San Raffaele, Milano, Italy.
Am J Gastroenterol. 2009 May;104(5):1119-24. doi: 10.1038/ajg.2009.53. Epub 2009 Mar 31.
The aim was to compare patients' and endoscopists' satisfaction in terms of efficacy and safety of remifentanil patient-controlled analgesia (PCA) during colonoscopy with that of a combination of midazolam and meperidine.
Sixty patients undergoing colonoscopy were randomly assigned to two groups. All of the patients received midazolam 0.03 mg/kg intravenously for premedication. In the remifentanil group, a bolus dose of remifentanil was given, and a patient-controlled sedation analgesia (PCSA) pump was set to inject further bolus doses with no "lockout" time. Patients in the meperidine group received a bolus of meperidine and sham PCSA. Non-invasive arterial blood pressure, electrocardiography, and pulse oximetry were monitored throughout the study. The Observer's Assessment of Alertness and Sedation Scale (OAA/S) was performed at baseline, every 5 min during, and after colonoscopy. Assessment of pain and satisfaction with sedoanalgesia was scheduled after colonoscopy and 24-72 h later by a 100 mm visual analog scale (VAS). The technical difficulty of the examination and the gastroenterologist's satisfaction were assessed similarly.
The degree of pain, the level of satisfaction with sedoanalgesia by patients and gastroenterologists, and the degree of difficulty experienced by the endoscopist were not different in the two groups. The time to reach an Aldrete score > or = 9 was significantly shorter in the remifentanil group (P < 0.0001); discharge times did not differ between the groups (P = 0.36). There was no difference between the groups regarding the duration of colonoscopy (P = 0.82) and the stability of vital signs. At the end of the procedure, OAA/S was significantly higher in the remifentanil group (P = 0.03).
Remifentanil PCA is safe and effective to induce sedoanalgesia during colonoscopy. Further studies should address the optimization of dosing and lock out setting.
旨在比较瑞芬太尼患者自控镇痛（PCA）与咪达唑仑和哌替啶联合使用在结肠镜检查期间的疗效和安全性方面患者及内镜医师的满意度。
60例行结肠镜检查的患者被随机分为两组。所有患者均静脉注射咪达唑仑0.03mg/kg进行术前用药。在瑞芬太尼组，给予负荷剂量的瑞芬太尼，并设置患者自控镇静镇痛（PCSA）泵以注射额外的负荷剂量且无“锁定”时间。哌替啶组患者接受负荷剂量的哌替啶及假PCSA。在整个研究过程中监测无创动脉血压、心电图和脉搏血氧饱和度。在基线、结肠镜检查期间每5分钟及检查后采用观察者警觉与镇静评分量表（OAA/S）进行评估。结肠镜检查后以及24 - 72小时后通过100mm视觉模拟量表（VAS）评估疼痛及对镇静镇痛的满意度。同样评估检查的技术难度及胃肠病学家的满意度。
两组在疼痛程度、患者及胃肠病学家对镇静镇痛的满意度水平以及内镜医师所经历的困难程度方面无差异。瑞芬太尼组达到Aldrete评分≥9分的时间显著更短（P < 0.0001）；两组出院时间无差异（P = 0.36）。两组在结肠镜检查持续时间（P = 0.82）及生命体征稳定性方面无差异。在操作结束时，瑞芬太尼组的OAA/S显著更高（P = 0.03）。
瑞芬太尼PCA在结肠镜检查期间诱导镇静镇痛是安全有效的。进一步的研究应关注给药剂量及锁定设置的优化。
