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

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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.	许国铭, 李兆申.上消化道内镜学[M].上海:上海科学技术出版社, 2003: 99.
5.	Sümpelmann R, Büsing H, Schröder D, et al. Patient-controlled analgesia with clonidine and piritramide[J]. Anaesthesist, 1996, 45(1): 88-94.
6.	耿志宇, 许幸, 吴新民.瑞芬太尼复合异丙酚靶控输注诱导时的量效关系[J].中华麻醉学杂志, 2004, 24(4): 260-263.
7.	朱姝, 陈志勇, 朱美华.不同剂量丙泊酚对无痛胃镜检查患者苏醒质量的影响[J].临床麻醉学杂志, 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.	钱刚, 张光明.芬太尼和瑞芬太尼复合异丙酚TCI给药对老年患者肠镜检查的比较[J].中国医学工程, 2010(2): 44-45.
10.	肖庆旺, 秦彩娟, 魏双江, 等.瑞芬太尼复合丙泊酚用于患者清醒状态下实施无痛宫腔镜手术的研究[J].河北医科大学学报, 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.	周仁龙, 王珊娟, 杭燕南, 等.瑞芬太尼对老年病人呼吸功能的影响[J].中华麻醉学杂志, 2007, 27(2): 111-113.
13.	肖庆旺, 秦彩娟, 宋慧芳, 等.瑞芬太尼复合丙泊酚用于老年患者清醒状态下肩关节脱位手法复位的研究[J].华西医学, 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. 许国铭, 李兆申.上消化道内镜学[M].上海:上海科学技术出版社, 2003: 99.
5. Sümpelmann R, Büsing H, Schröder D, et al. Patient-controlled analgesia with clonidine and piritramide[J]. Anaesthesist, 1996, 45(1): 88-94.
6. 耿志宇, 许幸, 吴新民.瑞芬太尼复合异丙酚靶控输注诱导时的量效关系[J].中华麻醉学杂志, 2004, 24(4): 260-263.
7. 朱姝, 陈志勇, 朱美华.不同剂量丙泊酚对无痛胃镜检查患者苏醒质量的影响[J].临床麻醉学杂志, 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. 钱刚, 张光明.芬太尼和瑞芬太尼复合异丙酚TCI给药对老年患者肠镜检查的比较[J].中国医学工程, 2010(2): 44-45.
10. 肖庆旺, 秦彩娟, 魏双江, 等.瑞芬太尼复合丙泊酚用于患者清醒状态下实施无痛宫腔镜手术的研究[J].河北医科大学学报, 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. 周仁龙, 王珊娟, 杭燕南, 等.瑞芬太尼对老年病人呼吸功能的影响[J].中华麻醉学杂志, 2007, 27(2): 111-113.
13. 肖庆旺, 秦彩娟, 宋慧芳, 等.瑞芬太尼复合丙泊酚用于老年患者清醒状态下肩关节脱位手法复位的研究[J].华西医学, 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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