Adding Low-Dose Propofol to Limit Anxiety during Target-Controlled Infusion of Remifentanil for Gastrointestinal Endoscopy: Respiratory Issues and Safety Recommendations
Abstract
:1. Introduction
2. Methods
- Demographic data;
- Remifentanil and propofol dosing data;
- Number of patients who completed the procedure without rescue medications or switching to general anesthesia, patient satisfaction, and willingness to have the same technique for a future procedure;
- Depth of sedation, expressed by the minimal value of Modified Observer’s Assessment of Alertness/Sedation Scale [12]. with grading from 0 = no response after painful trapezius squeeze to 5 = responds readily to name spoken in normal tone;
- Maximal value on the Pain Numeric Scale (from 0 to 10) during the procedure;
- Respiratory depression assessed by the minimal value of respiratory rate and SpO2 and the number of respiratory depression episodes responding to target adjustment or requiring jaw thrust or ventilation;
- Hemodynamic stability through minimum and maximum values of mean blood pressure (MBP) and heart rate (HR), as well as doses of rescue medications (atropine, ephedrine) given;
- Satisfaction, happiness, and readiness for the same procedure with the same analgesic protocol;
- Incidence of PONV upon arrival in the PACU;
3. Results
- 62% of patients had a minimal respiratory rate < 8 breaths/min (vs. 21%);
- 26.7% had minimal SpO2 < 90% (vs. 6.9%);
- 13.3% needed jaw thrust (vs. 0%).
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Center 1 (n = 29) Remi | Center 2 (n = 60) Propofol/Remi | p | |
---|---|---|---|
Age (y) | 61 ± 12 | 59 ± 15 | NS |
Patients > 50 y (%) | 82.8% | 75% | NS |
Gender (male/female) | 12/17 | 37/23 | NS |
ASA status I/II/III/IV | 3/17/7/2 | 12/32/15/1 | NS |
BMI kg.m−2 | 27 ± 6 | 26 ± 5 | NS |
Patients > 35 kg.m−2 (%) | 10.3% | 6.8% | NS |
Coloscopy/upper endoscopy/both | 16/2/11 | 36/4/20 | NS |
Anesthesia duration (min) | 23 ± 21 | 21 ± 12 | NS |
Center 1 (n = 29) Remi | Center 2 (n = 60) Propofol/Remi | p | |
---|---|---|---|
Number of successes without rescue | 27 (93%) | 52 (87%) | NS |
At least 1 agitation episode | 8 (28%) | 16 (27%) | NS |
Happy or very happy/moderately unhappy or unhappy | 22/3 | 49/11 | NS |
Ready for a new procedure (Y/N) | 24/1 | 48/9 | NS |
PONV | 5 (17.2%) | 7 (11.7%) | NS |
Total dose of remifentanil (µg) | 208 ± 103 | 248 ± 132 | NS |
Average remifentanil rate (µg·kg−1·min−1) | 0.19 ± 0.17 | 0.18 ± 0.07 | NS |
Maximum remifentanil target (ng·mL−1) | 3.6 ± 1.37 | 5.1 ± 1.5 | <0.001 |
Number remifentanil target adjustments | 2 ± 1.7 | 2.8 ± 2 | 0.056 |
Propofol boluses | 2 patients had a 10 mg bolus; others had no propofol | 8 patients received more than 1 bolus; all others received 1 initial bolus | |
Total propofol dose (mg) | 0.7 ± 3 [0, 10] | 13 ± 8 [5, 50] | <0.001 |
Maximum pain scale | 2.6 ± 2.3 | 4.3 ± 2.8 | 0.004 |
OAA/S 3.4 | 5 (17%) | 34 (57%) | 0.0004 |
Center 1 (n = 29) Remi | Center 2 (n = 60) Propofol/Remi | p | |
---|---|---|---|
Min. SpO2 (%) | 96 ± 3 | 93.2 ± 9.5 | 0.046 |
Min. SpO2 < 90% | 2 (6.9%) | 16 (26.7%) | 0.0295 |
Min. resp. rate (min−1) | 11 ± 4 | 7 ± 5 | <0.0001 |
Min. resp. rate < 8 min−1 | 6 (21%) | 37 (62%) | 0.0003 |
Patients requiring jaw thrust | 0 | 8 (13%) | 0.039 |
Mask ventilation | 0 | 5 (8%) | NS |
Min. resp. rate in PACU | 9 ± 3 | 13 ± 2 | 0.0004 |
Min SpO2 in PACU | 95.3 ± 1.8 | 97.3 ± 2.2 | <0.0001 |
Center 1 Remi | Center 2 Propofol/Remi | p | |
---|---|---|---|
Min. MBP (mmHg) | 90 ± 14 | 92 ± 17 | NS |
Max. MBP (mmHg) | 108 ± 18 | 118 ± 24 | 0.029 |
Min. HR (bpm) | 72 ± 12 | 64 ± 13 | 0.014 |
Max. HR (bpm) | 96 ± 20 | 86 ± 19 | 0.027 |
Atropine/ephedrine | 0/0 | 0/0 | - |
Min. MBP in PACU (mmHg) | 87 ± 9 | 100 ± 19 | 0.056 |
Min HR in PACU (bpm) | 71 ± 14 | 65 ± 11 | 0.002 |
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Motamed, C.; Servin, F.; Billard, V. Adding Low-Dose Propofol to Limit Anxiety during Target-Controlled Infusion of Remifentanil for Gastrointestinal Endoscopy: Respiratory Issues and Safety Recommendations. Medicina 2022, 58, 1285. https://doi.org/10.3390/medicina58091285
Motamed C, Servin F, Billard V. Adding Low-Dose Propofol to Limit Anxiety during Target-Controlled Infusion of Remifentanil for Gastrointestinal Endoscopy: Respiratory Issues and Safety Recommendations. Medicina. 2022; 58(9):1285. https://doi.org/10.3390/medicina58091285
Chicago/Turabian StyleMotamed, Cyrus, Frederique Servin, and Valerie Billard. 2022. "Adding Low-Dose Propofol to Limit Anxiety during Target-Controlled Infusion of Remifentanil for Gastrointestinal Endoscopy: Respiratory Issues and Safety Recommendations" Medicina 58, no. 9: 1285. https://doi.org/10.3390/medicina58091285