Comparison ofetomidate-remifentanil and propofol-remifentanil sedation in patients schehuled for colonoscopy

SUMMARYComparison of Etomidate-Remifentanil and Propofol-Remifentanil Sedation in PatientsScheduled for ColonoscopySalime Toklu, Dokuz Eylül University, Medical School, Department of Anesthesiologyand ReanimationObjective: Alt gastrointestinal sistem hastalıklarının araştırılmasında temel tanıyöntemi kolonoskopi olup, günübirlik işlem şeklinde yapılmaColonoscopy is the basic diagnostic method for the investigation of lowergastrointestinal tract disorders, and can be performed as an outpatient procedure Theprocedure is unpleasant and uncomfortable in practice.Pain and vasovagal reactions that needsedative and analgesic medication are common.The aim of the study is to comparehemodynamic responses, recovery and discharge times, and physician satisfaction ofetomidate-remifentanil and propofol-remifentanil combinations in patients undergoingelective colonoscopy.Methods:Sixty ASA 1-2 patients, aged between 18-65, scheduled for elective colonoscopyunder sedation/analgesia, were prospectively randomized for the study. Two minutes after thebeginning of continuous remifentanil infusion (0.1 μg/kg/min), hypnotic agents (etomidate orpropofol) were administered. Cases were randomized into two groups (group E and P), withclosed envelope technique. Group E patients received 0.05 mg/kg maintenance dose ofetomidate after an initial dose of 0.1 mg/kg and Group P patients received 0.25 mg/kgmaintenance dose of propofol after an initial dose of 0.5 mg/kg in order to have a Ramsaysedation score (RSS) of 3-4. Basal values of heart rate (HR), systolic arterial pressure (SAP),diastolic arterial pressure (DAP), mean arterial pressure (MAP), oxygen saturation (SpO2),respiratory rate and Ramsay sedation scores were recorded. Values were recorded every 2minutes for the first 10 minutes and every 5 minutes thereafter, until the completion of theprocedure. Total drug dosages, procedure time, interval between the cessation of remifentanilinfusion to the time point were a Ramsay score of 2 eligible (time for taking patient to thepostoperative care unit), recovery time and adverse effects were recorded additionally.viiiPDF created with pdfFactory Pro trial version www.pdffactory.comResults:The demographic data between two groups were not statistically significant. MAPbetween two groups were not significant at minutes 0, 2 , 35 , 40; whereas MAP werestatistically lower at minutes 4 , 6 , 8 ,10 ,15 ,20, 25 in group P (p= 0,001). At min. 8 andmin. 30, mean HR values were statistically lower ( p=0.03, p= 0.02 respectively) in group P.There was no difference at the other time intervals. Mean respiratory frequency betweengroups at min. 0, 2,4,30,35,40,45 were not significant, whereas mean respiratory frequencyvalues in group P at min. 6, 8, 10, 15, 20, 25 were statistically lower (p< 0.05). No statisticalsignificance was determined in SpO2 and RSS values between groups ( p> 0.050).Mean cecal intubation and total colonoscopy time values were not statistically significantbetween groups. Entrance time to postoperative care unit and recovery time values werestatistically shorter in group E. (respectively, p = 0.001, p= 0.01)Apnea and hypotension incidence was statistically higher in Group P ( p=0.001). Nausea,vomiting and myoclonus was statistically higher in group E ( p= 0.02, p= 0.01 respectively).Injection site pain was statistically higher in group P. (p=0.005). No statistical significancewas established in terms of bradycardia. ( p= 0.20). Physician satisfaction in both groups wassimilar.Discussion:Etomidate and remifentanil administration for sedation and analgesia duringcolonoscopy resulted in more stable hemodynamic effects, shorter recovery and dischargetime in this study; thus etomidate and remifentanil administration may be preferred topropofol-remifentanil administration for sedation and analgesia in patients undergoingcolonoscopy.Keywords: Colonoscopy, sedation/analgesia, etomidate, propofol, remifentanilixPDF created with pdfFactory Pro trial version www.pdffactory.com