Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.03.003
Brazilian Journal of Anesthesiology
Clinical Research

Effects of remifentanil on awakening of propofol sedated patients submitted to upper gastrointestinal endoscopy: a randomized clinical trial

Efeitos do remifentanil sobre despertar de pacientes sedados com propofol para endoscopia digestiva alta: estudo clínico randomizado

Gustavo Nadal Uliana, Elizabeth Milla Tambara, Renato Tambara Filho, Giorgio Alfredo Pedroso Baretta

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Abstract

Background and objectives
Sedation for endoscopic procedures aims to provide high quality sedation, lower risks, short recovery time, superior recovery quality and absence of side effects, seeking high patient level of satisfaction. The goal of the study was to assess administration of remifentanil combined with propofol regarding the effects of the drug association during sedation and recovery for patients submitted to upper gastrointestinal diagnostic endoscopy.

Method
One hundred and five patients were assessed, randomly divided into three groups of 35 patients. The Control Group was sedated with propofol alone. Study Group 1 was sedated with a fixed dose of 0.2 μg.kg−1 remifentanil combined with propofol. Study Group 2 was sedated with 0.3 μg.kg−1 remifentanil combined with propofol. We assessed the quality of sedation, hemodynamic parameters, incidence of significant hypoxemia, time for spontaneous eye opening, post-anesthetic recovery time, quality of post-anesthetic recovery, presence of side effects and patient satisfaction.

Results
Study Group 1 showed better quality of sedation. The groups in which remifentanil was administered combined with propofol showed shorter eye-opening time and shorter post-anesthetic recovery time compared to the control group. The three groups presented hemodynamic changes at some of the moments assessed. The incidence of significant hypoxemia, the quality of post-anesthetic recovery, the incidence of side effects and patient satisfaction were similar in the three groups.

Conclusions
The combination of propofol with remifentanil at a dose of 0.2 μg.kg−1 was effective in improving the quality of sedation, and at doses of 0.2 μg.kg−1 and 0.3 μg.kg−1 reduced the time to spontaneous eye opening and post-anesthetic recovery in comparison to sedation with propofol administered alone.

Keywords

Sedation;  Upper gastrointestinal diagnostic endoscopy;  Propofol;  Remifentanil;  Anesthetic recovery

Resumo

Justificativa e objetivos
A sedação para procedimentos endoscópicos pretende fornecer boa qualidade de sono, menores riscos, tempo de recuperação mais curto, qualidade de recuperação superior e ausência de efeitos colaterais, buscando um elevado nível de satisfação dos pacientes. O objetivo deste estudo foi avaliar a influência da associação do remifentanil ao propofol e seus efeitos durante a sedação e a recuperação em exames de endoscopia digestiva alta diagnóstica.

Método
Foram avaliados 105 pacientes, divididos aleatoriamente em três grupos de 35 pacientes. O Grupo Controle foi sedado apenas com o uso de propofol, o Grupo de Estudo 1 foi sedado com uso de remifentanil em dose fixa de 0,2 μg.kg−1 associado ao propofol. E o Grupo de Estudo 2 foi sedado com o uso de remifentanil em dose fixa de 0,3 μg.kg−1 associado ao propofol. Foram avaliados qualidade da sedação, comportamento hemodinâmico, incidência de hipoxemia significativa, tempo para abertura ocular espontânea, tempo de recuperação pós-anestésica, qualidade da recuperação pós-anestésica, presença de efeitos colaterais e satisfação do paciente.

Resultado
O Grupo de Estudo 1 apresentou melhor qualidade de sedação. Os grupos em que se associou o remifentanil apresentaram tempo para abertura ocular e tempo de recuperação anestésica mais curtos em relação ao grupo controle. Os três grupos apresentaram alterações hemodinâmicas em algum dos momentos avaliados. A incidência de hipoxemia significativa, a qualidade da recuperação pós-anestésica, a incidência de efeitos colaterais e a satisfação dos pacientes foram similares nos três grupos.

Conclusão
Conclui-se que a associação do remifentanil na dose de 0,2 μg.kg−1 mostrou-se efetivo na melhora da qualidade da sedação, e nas doses 0,2 μg.kg−1 e de 0,3 μg.kg−1, reduziu o tempo de abertura ocular espontânea e o tempo de recuperação pós-anestésica dos pacientes em relação a sedação apenas com propofol.

Palavras-chave

Sedação;  Endoscopia digestiva alta diagnósticos;  Propofol;  Remifentanil;  Recuperação anestésica

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