Department of Internal Medicine, Digestive Disease Centre, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea.
Dig Endosc. 2015 Jan;27(1):113-20. doi: 10.1111/den.12383. Epub 2014 Nov 11.
Although the combination of midazolam-meperidine has been widely used as a sedation regimen for colonoscopy, its residual effect which is longer than the duration of a colonoscopy procedure can delay patient recovery and discharge. Remifentanil, an ultra-short-acting opioid, has a very brief duration of action. We hypothesized that using remifentanil alone for colonoscopy would provide shorter recovery time compared with the midazolam-meperidine combination.
Time to achieve Aldrete score = 10 was determined and compared in patients who were randomly allocated to receive remifentanil alone (group-R, n = 27) or a midazolam-meperidine combination (group-MM, n = 27) for colonoscopy. Intergroup differences in sedation, recall analgesia, cardio-respiratory profiles, and satisfaction of patient and endoscopist were also determined during and after colonoscopy.
Group-R showed a significantly shorter recovery time than group-MM (median [25-75%], 0 [0-10] vs 30 [15-30] min, P < 0.001). Group-R showed significantly higher bispectral-index values during colonoscopy (92 [85-96] vs 84 [80-87], P = 0.001); a higher incidence of recall of explanations given during and after colonoscopy (100 vs 48% and 96 vs 52%, both P < 0.001); and a lower distress score (visual analog scale 30/100 vs 37/100 mm, P = 0.002), than did group-MM. Neither extent of pain, incidence of hemodynamic instability nor incidence of respiratory depression differed between the groups.
Remifentanil for colonoscopy afforded faster recovery compared to midazolam-meperidine combination. It also provided greater patient-endoscopist communication and satisfaction with comparable patient analgesia and cardiorespiratory profile during colonoscopy.
虽然咪达唑仑-哌替啶联合用药已广泛用于结肠镜检查的镇静方案，但它的残留作用时间长于结肠镜检查过程，会延迟患者的恢复和出院。瑞芬太尼是一种超短效阿片类药物，作用时间非常短暂。我们假设单独使用瑞芬太尼进行结肠镜检查将比咪达唑仑-哌替啶联合用药提供更短的恢复时间。
确定并比较接受单独瑞芬太尼（组-R，n=27）或咪达唑仑-哌替啶联合用药（组-MM，n=27）的患者达到 Aldrete 评分=10 的时间。还在结肠镜检查期间和之后确定了镇静、回忆性镇痛、心肺功能以及患者和内镜医师的满意度的组间差异。
组-R 的恢复时间明显短于组-MM（中位数[25-75%]，0 [0-10] vs 30 [15-30]分钟，P<0.001）。组-R 在结肠镜检查期间显示出明显更高的双谱指数值（92 [85-96] vs 84 [80-87]，P=0.001）；在结肠镜检查期间和之后回忆起解释的发生率更高（100%比 48%和 96%比 52%，均 P<0.001）；和较低的痛苦评分（视觉模拟量表 30/100 比 37/100 毫米，P=0.002），与组-MM 相比。两组之间的疼痛程度、血流动力学不稳定的发生率或呼吸抑制的发生率均无差异。
与咪达唑仑-哌替啶联合用药相比，瑞芬太尼用于结肠镜检查可更快恢复。它还提供了更好的医患沟通和满意度，在结肠镜检查期间具有相似的患者镇痛和心肺功能。
