Patient-controlled sedation for ERCP: a randomized double-blind comparison of alfentanil and remifentanil

Endoscopy, 05/15/2012

Patient–controlled sedation (PCS) is an acceptable method of sedation for endoscopic retrograde cholangiopancreatography (ERCP). The combination of propofol and alfentanil should be recommended because a remifentanil – propofol mixture depresses spontaneous respiration more and produces nausea more frequently.

Methods

  • Eighty-one patients undergoing elective ERCP received PCS with propofol and opioid in three different regimens.
  • The concentrations of opioids in the sedative mixture were 0.02 mg/mL in the remifentanil group (R) and 0.04 mg/mL and 0.08 mg/mL in the alfentanil 1 (A1) and alfentanil 2 (A2) groups, respectively.
  • The infusion pump was adjusted to deliver a 1 mL single dose with zero lockout time.
  • The authors considered PCS as successful if no procedure interruption due to sedation-related complications occurred or if additional propofol was not needed.
  • The consumption of propofol was registered, and sedation levels and vital signs were monitored.
  • Endoscopist and patient satisfaction with sedation were assessed using structured questionnaires.

Results

  • The consumption (SD) of propofol was 177 (105)mg in group R, 197 (88) mg in group A1 and 162 (70)mg in group A2.
  • PCS was successful in 74 /81 (91 %) of sedations, without differences between the groups in terms of propofol consumption, sedation success rate, sedation levels, vital signs, postprocedural pain, and endoscopist and patient satisfaction.
  • Respiratory depression and nausea were observed more frequently with remifentanil than with alfentanil (P < 0.05).

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