Uliana Gustavo Nadal, Tambara Elizabeth Milla, Filho Renato Tambara, Baretta Giorgio Alfredo Pedroso
Universidade Federal do Paraná (UFPR), Programa de Pós-Graduação em Clínica Cirúrgica, Curitiba, PR, Brazil; Hospitais Vita, Serviço de Anestesiologia, Curitiba, PR, Brazil.
Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil; Pontifícia Universidade Católica do Paraná, Escola de Medicina, Disciplina de Anestesiologia, Curitiba, PR, Brazil.
Braz J Anesthesiol. 2020 May-Jun;70(3):262-270. doi: 10.1016/j.bjan.2020.03.004. Epub 2020 May 12.
Sedation for endoscopic procedures aims to provide high quality sedation, lower risks, short recovery time, superior recovery quality and absence of side effects, seeking high patient level of satisfaction. The goal of the study was to assess administration of remifentanil combined with propofol regarding the effects of the drug association during sedation and recovery for patients submitted to upper gastrointestinal diagnostic endoscopy.
One hundred and five patients were assessed, randomly divided into three groups of 35 patients. The Control Group was sedated with propofol alone. Study Group 1 was sedated with a fixed dose of 0.2 μg.kg remifentanil combined with propofol. Study Group 2 was sedated with 0.3 μg.kg remifentanil combined with propofol. We assessed the quality of sedation, hemodynamic parameters, incidence of significant hypoxemia, time for spontaneous eye opening, post-anesthetic recovery time, quality of post-anesthetic recovery, presence of side effects and patient satisfaction.
Study Group 1 showed better quality of sedation. The groups in which remifentanil was administered combined with propofol showed shorter eye-opening time and shorter post-anesthetic recovery time compared to the control group. The three groups presented hemodynamic changes at some of the moments assessed. The incidence of significant hypoxemia, the quality of post-anesthetic recovery, the incidence of side effects and patient satisfaction were similar in the three groups.
The combination of propofol with remifentanil at a dose of 0.2 μg.kg was effective in improving the quality of sedation, and at doses of 0.2 μg.kg and 0.3 μg.kg reduced the time to spontaneous eye opening and post-anesthetic recovery in comparison to sedation with propofol administered alone.
内镜检查的镇静旨在提供高质量的镇静效果，降低风险，缩短恢复时间，提高恢复质量且无副作用，以寻求患者的高度满意度。本研究的目的是评估瑞芬太尼联合丙泊酚用于上消化道诊断性内镜检查患者镇静及恢复过程中药物联合使用的效果。
对105例患者进行评估，随机分为三组，每组35例。对照组仅用丙泊酚镇静。研究组1用固定剂量0.2μg/kg瑞芬太尼联合丙泊酚镇静。研究组2用0.3μg/kg瑞芬太尼联合丙泊酚镇静。我们评估了镇静质量、血流动力学参数、严重低氧血症的发生率、自主睁眼时间、麻醉后恢复时间、麻醉后恢复质量、副作用的发生情况及患者满意度。
研究组1显示出更好的镇静质量。与对照组相比，使用瑞芬太尼联合丙泊酚的组睁眼时间和麻醉后恢复时间更短。三组在某些评估时刻均出现了血流动力学变化。三组的严重低氧血症发生率、麻醉后恢复质量、副作用发生率及患者满意度相似。
丙泊酚与0.2μg/kg剂量的瑞芬太尼联合使用可有效提高镇静质量，与单独使用丙泊酚镇静相比，0.2μg/kg和0.3μg/kg剂量的瑞芬太尼联合丙泊酚可缩短自主睁眼时间和麻醉后恢复时间。
