Department of Anaesthesia, Gustave Roussy Cancer Centre,Villejuif, France.
Department of Anaesthesia, Bichat Claude Bernard University Hospital, Paris, France.
J Opioid Manag. 2021 Jan-Feb;17(1):69-78. doi: 10.5055/jom.2021.0615.
Remifentanil, a rapid onset rapid offset synthetic opioid and potent analgesic, is often used for procedural conscious sedation in spontaneous ventilation, especially when delivered in target controlled infusion (TCI), which allows precise titration. We assessed efficacy, tolerance, and adverse events related with the use of remifentanil TCI during various procedures.
Prospective, observational.
Two teaching hospitals.
We enrolled 434 patients undergoing procedures suitable for conscious sedation.
The following procedures considered suitable were included: interventional radiology, gastrointestinal (GI) endoscopy, interventional cardiology, and peripheral dermatology. Sedation options were determined during the preoperative anesthesia assessment.
Demographics were recorded as well as success rate, remifentanil dosage, pain scores, respiratory or cardiovascular events, and patient and operator satisfaction.
The procedure was successful in 429 patients (99 percent), canceled in four patients because of agitation, apnea, desaturation, and converted to general anesthesia in two for major pain. The maximal remifentanil target was around 2-3 ng/ml for most procedures, but it was 3-5 ng/ml for GI endoscopy and urology. A total of 172 patients (40 percent) had bradypnea < 8 min, but only 26 (6 percent) had hypoxemia < 90 percent. Eighteen patients (4 percent) required mandibular luxation, and twelve needed face mask ventilation. There were no major cardiovascular adverse events.
Remifentanil TCI is a suitable protocol for procedural sedation, but respiratory depression is a permanent concern. This risk requires equipped environment and competent medical personnel on hand to adjust the target before hypoxemia occurs. Respiratory rate monitoring, based on capnography or thoracic impedance is of a great help in anticipating this threat.
瑞芬太尼是一种起效迅速、消除迅速的合成阿片类药物和强效镇痛药，常用于自主通气下的程序镇静，尤其是在靶控输注（TCI）下使用时，可精确滴定。我们评估了瑞芬太尼 TCI 在各种操作过程中的疗效、耐受性和与使用相关的不良事件。
前瞻性、观察性。
两所教学医院。
我们纳入了 434 名接受适合镇静程序的患者。
包括以下认为适合的程序：介入放射学、胃肠（GI）内镜、介入心脏病学和周围皮肤科。镇静选择在术前麻醉评估期间确定。
记录患者的人口统计学数据、成功率、瑞芬太尼剂量、疼痛评分、呼吸或心血管事件以及患者和操作者的满意度。
429 例患者（99%）手术成功，4 例患者因躁动、呼吸暂停、低氧血症而取消手术，2 例患者因剧烈疼痛转为全身麻醉。大多数程序的最大瑞芬太尼靶浓度约为 2-3ng/ml，但 GI 内镜和泌尿科为 3-5ng/ml。共有 172 例患者（40%）出现呼吸频率<8 分钟，但仅有 26 例患者（6%）出现低氧血症<90%。18 例患者（4%）需要下颌脱位，12 例需要面罩通气。无重大心血管不良事件。
瑞芬太尼 TCI 是程序镇静的合适方案，但呼吸抑制是一个持续存在的问题。这种风险需要配备有环境和有能力的医务人员在手，在发生低氧血症之前调整靶浓度。基于呼气末二氧化碳或胸部阻抗的呼吸频率监测有助于预测这种威胁。
