Prospective, randomized comparative study of respiratory and hemodynamic monitoring during colonoscopy using remifentanyl versus propofol/fentanyl

Abstract

Objective: We hypothesized that remifentanil continuous infusion during colonoscopy in spontaneous respiration may give benefits in terms of quality of sedation and recovery compared to propofol, and that patients' ventilatory drive and consciousness could be accurately evaluated by the continuous measurement of end-tidal CO2 (EtCO2), and of Bispectral Score (BIS) respectively. Methods: One-hundred and eighty patients scheduled for colonoscopy were randomized in two groups: 76 patients were included in Groupcontrol (propofol 0.5 mg/kg bolus plus infusion 1 mg/kg/h) and 78 patients in Gruopremi (0.5 mcg/Kg/1 min bolus plus infusion 0.08 mcg/kg/min, progressively reduced to 0.03 mcg/kg/min). Cardiovascular and respiratory variables were measured before induction and every 3 min throughout the procedure. Sedation level was estimated by BIS and Observer's Assessment of Alertness/Sedation Scale (OAA/S). Respiratory function was evaluated by arterial oxygen saturation (SaO2) and EtCO2. Recovery from sedation and hospital discharge criteria were assessed by Modified Aldrete Score System (APRS) 30 min after colonoscopy completion. Results: Remifentanil was effective and well tolerated during colonoscopy. Hemodynamic parameters remained stable throughout the study steps in both groups. In Groupremi OAA/S and BIS score were higher (p<0.001), and EtCO2 (p<0.5) lower that in Groupcontrol. Recovery time was faster in the Groupremi (p<0.01). Conclusions: Our data show that analgosedation with remifentanil allowed to obtain a good quality colonoscopy without respiratory and hemodynamic impairment and with faster recovery than moderate sedation propofol/fentanyl. Moreover, BIS and EtCO2 monitoring proved to be well suited to evaluate the trend variations of patients' sedation level and respiratory drive. © 2014 Mollica G, et al.