Department of Anesthesiology, Handan First Hospital of Hebei Province, Handan, Hebei, PR China.
2nd Gastroenterology Department, Handan First Hospital of Hebei Province, Handan, Hebei, PR China.
Medicine (Baltimore). 2024 Apr 12;103(15):e37411. doi: 10.1097/MD.0000000000037411.
Colonoscopy is a commonly performed gastroenterological procedure in patients associated with anxiety and pain. Various approaches have been used to provide sedation and analgesia during colonoscopy, including patient-controlled analgesia and sedation (PCAS). This study aims to evaluate the feasibility and efficiency of PCAS administered with propofol and remifentanil for colonoscopy.
This randomized controlled trial was performed in an authorized and approved endoscopy center. A total of 80 outpatients were recruited for the colonoscopy studies. Patients were randomly allocated into PCAS and total intravenous anesthesia (TIVA) groups. In the PCAS group, the dose of 0.1 ml/kg/min of the mixture was injected after an initial bolus of 3 ml mixture (1 ml containing 3 mg of propofol and 10 μg of remifentanil). Each 1 ml of bolus was delivered with a lockout time of 1 min. In the TIVA group, patients were administered fentanyl 1 μg/kg, midazolam 0.02 mg/kg, and propofol (dosage titrated). Cardiorespiratory parameters and auditory evoked response index were continuously monitored during the procedure. The recovery from anesthesia was assessed using the Aldrete scale and the Observer's Assessment of Alertness/Sedation Scale. The Visual Analogue Scale was used to assess the satisfaction of patients and endoscopists.
No statistical differences were observed in the Visual Analogue Scale scores of the patients (9.58 vs 9.50) and the endoscopist (9.43 vs 9.30). A significant decline in the mean arterial blood pressure, heart rate, and auditory evoked response index parameters was recorded in the TIVA group (P < 0.05). The recovery time was significantly shorter in the PCAS group than in the TIVA group (P = 0.00).
The combination of remifentanil and propofol could provide sufficient analgesia, better hemodynamic stability, lighter sedation, and faster recovery in the PCAS group of patients compared with the TIVA group.
结肠镜检查是一种在伴有焦虑和疼痛的患者中常进行的胃肠病学程序。在结肠镜检查期间，已经使用了各种方法来提供镇静和镇痛，包括患者自控镇痛和镇静（PCAS）。本研究旨在评估使用丙泊酚和瑞芬太尼进行 PCAS 用于结肠镜检查的可行性和效率。
这项随机对照试验是在一家授权和批准的内窥镜中心进行的。共有 80 名门诊患者被招募进行结肠镜检查研究。患者被随机分配到 PCAS 和全凭静脉麻醉（TIVA）组。在 PCAS 组中，在初始推注 3ml 混合物（1ml 含 3mg 丙泊酚和 10μg 瑞芬太尼）后，以 0.1ml/kg/min 的剂量注射混合物。每次 1ml 推注的锁定时间为 1min。在 TIVA 组中，患者给予芬太尼 1μg/kg、咪达唑仑 0.02mg/kg 和丙泊酚（剂量滴定）。在整个过程中连续监测心肺参数和听觉诱发电位指数。使用 Aldrete 量表和观察者警觉/镇静量表评估麻醉恢复情况。使用视觉模拟量表评估患者和内镜医师的满意度。
患者（9.58 与 9.50）和内镜医师（9.43 与 9.30）的视觉模拟量表评分无统计学差异。TIVA 组的平均动脉血压、心率和听觉诱发电位指数参数明显下降（P <0.05）。PCAS 组的恢复时间明显短于 TIVA 组（P =0.00）。
与 TIVA 组相比，丙泊酚和瑞芬太尼的联合使用可为 PCAS 组患者提供足够的镇痛、更好的血流动力学稳定性、更轻的镇静作用和更快的恢复。
