Patient-controlled Analgesia and Sedation with Remifentanil and Propofol for Colonoscopy in Elderly Patients_West China Medical Journal

Authors：

 SongHuayong ¹ , ZhangTao ¹ , ZhangGuangxin ¹ , MaXingjuan ² , LiuJuan ³ ,  WangXiao ³ , WangChunhui ⁴

1. Department of Anesthesiology; the First Hospital of Handan City, Handan, Hebei 056002, P. R. China;
2. Operating Room; the First Hospital of Handan City, Handan, Hebei 056002, P. R. China;
3. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
4. Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

WangXiao, Email: wangxiao2005@hotmail.com

Keywords：

Remifentanil; Propofol; Patient-controlled analgesia and sedation; Colonoscopy; Elderly patients

DOI：

10.7507/1002-0179.201600463

Video：

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Objective To evaluate the feasibility and efficiency of patient-controlled analgesia and sedation (PCAS) with propofol and remifentanil for colonoscopy in elderly patients. Methods Sixty elderly patients preparing for painless colonoscopy between May and September 2015 were randomly allocated into PCAS group and total intravenous anesthesia (TIVA) group with 30 patients in each. In the PCAS group, the mixture of remifentanil and propofol at 0.6 mL/(kg·h) was pumped continuously after an initial bolus of 0.05 mL/kg mixture. The examination began three minutes after the infusion was finished. Patients could press the self-control button. Each bolus delivered 1 mL and the lockout time was 1 minute. In the TIVA group, patients received fentanyl at 1 μg/kg and midazolam at 0.02 mg/kg intravenously, and accepted intravenous propofol at 0.8-1.0 mg/kg two minutes later. The examination began when the patients lost consciousness. Results A significant decline of mean arterial blood pressure was detected within each group after anesthesia (P < 0.05). The decrease of mean blood pressure in the TIVA group was more significant than that in the PCAS group (P < 0.05). The heart rate, pulse oxygen saturation and respiratory rate decreased significantly after anesthesia in both the two groups (P < 0.05), while end-tidal CO2 increased after anesthesia without any significant difference between the two groups (P > 0.05). The induction time, time to insert the colonoscope to ileocecus, and total examination time were not significantly different between the two groups (P > 0.05). As for the time from the end of examination to OAA/S score of 5 and to Aldrete score of 9, the PCAS group was significantly shorter than the TIVA group (P < 0.05). Conclusion PCAS with remifentanil and propofol can provide sufficient analgesia, better hemodynamic stability, lighter sedation, and faster recovery compared with TIVA.

Citation： SongHuayong, ZhangTao, ZhangGuangxin, MaXingjuan, LiuJuan, WangXiao, WangChunhui. Patient-controlled Analgesia and Sedation with Remifentanil and Propofol for Colonoscopy in Elderly Patients. West China Medical Journal, 2016, 31(10): 1682-1685. doi: 10.7507/1002-0179.201600463 Copy

1.	Williams CB. Comfort and quality in colonoscopy[J]. Gastrointest Endosc, 1995, 40(6): 769-770.
2.	Chernik DA, Gillings D, Laine H, et al. Validity and reliability of the Observer's Assessment of Alertness/Sedation Scale: study with intravenous midazolam[J]. J Clin Psychopharmacol, 1990, 10(4): 244-251.
3.	Aldrete JA. The post-anesthesia recovery score revisited[J]. J Clin Anesth, 1995, 7(1): 89-91.
4.	許國銘, 李兆申.上消化道內鏡學[M].上海:上海科學技術出版社, 2003: 99.
5.	Sümpelmann R, Büsing H, Schr?der D, et al. Patient-controlled analgesia with clonidine and piritramide[J]. Anaesthesist, 1996, 45(1): 88-94.
6.	耿志宇, 許幸, 吳新民.瑞芬太尼復合異丙酚靶控輸注誘導時的量效關系[J].中華麻醉學雜志, 2004, 24(4): 260-263.
7.	朱姝, 陳志勇, 朱美華.不同劑量丙泊酚對無痛胃鏡檢查患者蘇醒質量的影響[J].臨床麻醉學雜志, 2016, 32(7): 705-706.
8.	Egan TD, Minto CF, Hermann DJ, et al. Remifentanil versus alfentanil: comparative pharmacokinetics and pharmacodynamics in healthy adult male volunteers[J]. Anesthesiology, 1996, 84(4): 821-833.
9.	錢剛, 張光明.芬太尼和瑞芬太尼復合異丙酚TCI給藥對老年患者腸鏡檢查的比較[J].中國醫學工程, 2010(2): 44-45.
10.	肖慶旺, 秦彩娟, 魏雙江, 等.瑞芬太尼復合丙泊酚用于患者清醒狀態下實施無痛宮腔鏡手術的研究[J].河北醫科大學學報, 2014, 35(1): 99-102.
11.	Nieuwenhuijs DF, Erik O, Romberg RR, et al. Response surface modeling of remifentanil-propofol interaction on cardiorespiratory control and bispectral index[J]. Anesthesiology, 2003, 98(2): 312-322.
12.	周仁龍, 王珊娟, 杭燕南, 等.瑞芬太尼對老年病人呼吸功能的影響[J].中華麻醉學雜志, 2007, 27(2): 111-113.
13.	肖慶旺, 秦彩娟, 宋慧芳, 等.瑞芬太尼復合丙泊酚用于老年患者清醒狀態下肩關節脫位手法復位的研究[J].華西醫學, 2015(4): 673-676.
14.	Gold MI, Watkins WD, Sung YF, et al. Remifentanil versus remifentanil/midazolam for ambulatory surgery during monitored anesthesia care[J]. Anesthesiology, 1997, 87(1): 51-57.
15.	Rudner R, Jalowiecki P, Kawecki P, et al. Conscious analgesia/sedation with remifentanil and propofol versus total intravenous anesthesia with fentanyl, midazolam, and propofol for outpatient colonoscopy[J]. Gastrointest Endosc, 2003, 57(6): 657-663.

1. Williams CB. Comfort and quality in colonoscopy[J]. Gastrointest Endosc, 1995, 40(6): 769-770.
2. Chernik DA, Gillings D, Laine H, et al. Validity and reliability of the Observer's Assessment of Alertness/Sedation Scale: study with intravenous midazolam[J]. J Clin Psychopharmacol, 1990, 10(4): 244-251.
3. Aldrete JA. The post-anesthesia recovery score revisited[J]. J Clin Anesth, 1995, 7(1): 89-91.
4. 許國銘, 李兆申.上消化道內鏡學[M].上海:上海科學技術出版社, 2003: 99.
5. Sümpelmann R, Büsing H, Schr?der D, et al. Patient-controlled analgesia with clonidine and piritramide[J]. Anaesthesist, 1996, 45(1): 88-94.
6. 耿志宇, 許幸, 吳新民.瑞芬太尼復合異丙酚靶控輸注誘導時的量效關系[J].中華麻醉學雜志, 2004, 24(4): 260-263.
7. 朱姝, 陳志勇, 朱美華.不同劑量丙泊酚對無痛胃鏡檢查患者蘇醒質量的影響[J].臨床麻醉學雜志, 2016, 32(7): 705-706.
8. Egan TD, Minto CF, Hermann DJ, et al. Remifentanil versus alfentanil: comparative pharmacokinetics and pharmacodynamics in healthy adult male volunteers[J]. Anesthesiology, 1996, 84(4): 821-833.
9. 錢剛, 張光明.芬太尼和瑞芬太尼復合異丙酚TCI給藥對老年患者腸鏡檢查的比較[J].中國醫學工程, 2010(2): 44-45.
10. 肖慶旺, 秦彩娟, 魏雙江, 等.瑞芬太尼復合丙泊酚用于患者清醒狀態下實施無痛宮腔鏡手術的研究[J].河北醫科大學學報, 2014, 35(1): 99-102.
11. Nieuwenhuijs DF, Erik O, Romberg RR, et al. Response surface modeling of remifentanil-propofol interaction on cardiorespiratory control and bispectral index[J]. Anesthesiology, 2003, 98(2): 312-322.
12. 周仁龍, 王珊娟, 杭燕南, 等.瑞芬太尼對老年病人呼吸功能的影響[J].中華麻醉學雜志, 2007, 27(2): 111-113.
13. 肖慶旺, 秦彩娟, 宋慧芳, 等.瑞芬太尼復合丙泊酚用于老年患者清醒狀態下肩關節脫位手法復位的研究[J].華西醫學, 2015(4): 673-676.
14. Gold MI, Watkins WD, Sung YF, et al. Remifentanil versus remifentanil/midazolam for ambulatory surgery during monitored anesthesia care[J]. Anesthesiology, 1997, 87(1): 51-57.
15. Rudner R, Jalowiecki P, Kawecki P, et al. Conscious analgesia/sedation with remifentanil and propofol versus total intravenous anesthesia with fentanyl, midazolam, and propofol for outpatient colonoscopy[J]. Gastrointest Endosc, 2003, 57(6): 657-663.

West China Medical Journal

Patient-controlled Analgesia and Sedation with Remifentanil and Propofol for Colonoscopy in Elderly Patients

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