Lionel Bouvet

[Remifentanil is an effective alternative to propofol for patient-controlled analgesia during digestive endoscopic procedures].

PURPOSE Unlike propofol, the self-administration of remifentanil for sedation in gastrointestinal endoscopies has never been evaluated formally. We wanted to compare the efficacy and tolerance of patient self-administration of remifentanil vs propofol during gastrointestinal endoscopy. METHOD This prospective randomized, single-blinded study, included 77 patients undergoing gastrointestinal endoscopy. Patients were divided into two groups: group R received remifentanil (5 microg.kg(-1).hr(-1) infusion, 25 microg boli, refractory period of five minutes) and group P received propofol (2 mg.kg(-1).hr(-1) infusion, 0.5 mg.kg(-1) boli, refractory period of ten minutes). A 1 mg.kg(-1) bolus of propofol was administered before the procedure began in cases of marked anxiety. Additional boli of 25 microg of remifentanil or 0.5 mg.kg(-1) of propofol were administered when patients complained during the refractory period. The evaluation targeted analgesic efficacy during the procedure and patient satisfaction. The degree of sedation during the procedure and the occurrence of adverse reactions were analyzed. RESULTS Patient satisfaction was high and comparable in both groups, with the number of awake and oriented patients being significantly higher in group R. Hemodynamic and respiratory tolerance was comparable in both groups, despite two episodes of desaturation in group R. The incidence of nausea was significantly higher in group R. CONCLUSIONS The self-administration of remifentanil for sedation during gastrointestinal endoscopies is as effective as the self-administration of propofol and can be offered to patients, especially when it is desirable that they remain conscious during the procedure.ObjectifA la différence du propofol, l’auto-administration de rémifentanil en sédation pour endoscopie digestive n’a jamais été évaluée dans la littérature. Nous avons voulu comparer l’efficacité et la tolérance de l’auto-administration de rémifentanil ou de propofol par le patient lors d’endoscopies digestives.MéthodeL’étude prospective, randomisée en simple aveugle, a été réalisée auprès de 77 patients devant bénéficier d’endoscopie digestive, répartis en deux groupes : groupe R = administration de rémifentanil (débit continu 5 μg·kg−1·h−1, bolus 25 μg, période réfractaire cinq minutes) et groupe P = administration de propofol (débit continu 2 mg·kg−1·h−1, bolus 0,5 mg·kg−1, période réfractaire dix minutes). Un bolus de 1 mg·kg−1 de propofol était administré avant le début de l’examen en cas d’anxiété importante. Des boli supplémentaires de 25 μg de rémifentanil ou de 0,5 mg·kg−1 de propofol étaient administrés en cas de plainte survenant en période réfractaire. L’évaluation a porté sur l’efficacité analgésique pendant l’examen et sur la satisfaction des patients. Le niveau de sédation pendant l’examen et la survenue d’effets indésirables ont été analysés.RésultatsLa satisfaction des patients était élevée et comparable dans les deux groupes, avec un nombre de patient réveillés et orientés significativement plus élevé dans le groupe R. La tolérance hémodynamique et respiratoire était comparable dans les deux groupes, malgré la survenue de deux épisodes de désaturation dans le groupe R. L’incidence des nausées était significativement plus importante dans le groupe R.ConclusionsL’auto-administration de rémifentanil en sédation pour endoscopie digestive est aussi efficace que l’auto-administration de propofol et peut être proposée notamment lorsque la perte de connaissance du patient n’est pas souhaitée.AbstractPurposeUnlike propofol, the self-administration of remifentanil for sedation in gastrointestinal endoscopies has never been evaluated formally. We wanted to compare the efficacy and tolerance of patient self-administration of remifentanil vs propofol during gastrointestinal endoscopy.MethodThis prospective randomized, single-blinded study, included 77 patients undergoing gastrointestinal endoscopy. Patients were divided into two groups: group R received remifentanil (5 μg·kg−1·hr−1 infusion, 25 μg boli, refractory period of five minutes) and group P received propofol (2 mg·kg−1·hr−1 infusion, 0.5 mg·kg−1 boli, refractory period of ten minutes). A 1 mg·kg−1 bolus of propofol was administered before the procedure began in cases of marked anxiety. Additional boli of 25 μg of remifentanil or 0.5 mg·kg−1 of propofol were administered when patients complained during the refractory period. The evaluation targeted analgesic efficacy during the procedure and patient satisfaction. The degree of sedation during the procedure and the occurrence of adverse reactions were analyzed.ResultsPatient satisfaction was high and comparable in both groups, with the number of awake and oriented patients being significantly higher in group R. Hemodynamic and respiratory tolerance was comparable in both groups, despite two episodes of desaturation in group R. The incidence of nausea was significantly higher in group R.ConclusionsThe self-administration of remifentanil for sedation during gastrointestinal endoscopies is as effective as the self-administration of propofol and can be offered to patients, especially when it is desirable that they remain conscious during the procedure.

Chronobiology of postoperative pain: it's time to wake up!

AIN management remains one of the anes-thesiologist’s major concerns. For a consid-erable period of time, clinical studies have focused on the discovery of new analgesic agents, on their optimal administration modalities, and on the development of strategies that target dif-ferent receptors as part of a multimodal analgesic strat-egy. Despite rather extensive research, there remains a subgroup of patients who remain unhappy with their treatment, whether for acute or chronic pain. The study presented by Boscariol et al.