Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1016/j.bjan.2012.07.006
Brazilian Journal of Anesthesiology
Scientific Article

Sedação e analgesia em colonoscopia eletiva: propofol-fentanil versus propofol-alfentanil

Sedation-analgesia in elective colonoscopy: propofol-fentanyl versus propofol-alfentanil

Hacer Ş; ebnem Türk; Meltem Aydoğ; muş; ; Oya Ünsal; Hakan Mustafa Köksal; Mehmet Eren Açik; Sibel Oba

http://dx.doi.org/10.1016/j.bjan.2012.07.006 Braz J Anesthesiol, vol.63, n4, p.353-358, 2013
PDF Português
PDF English
Downloads: 0
Views: 1126

Resumo

JUSTIFICATIVA E OBJETIVO: Sedação e analgesia são recomendadas em colonoscopia para propiciar conforto, pois são procedimentos invasivos e podem ser dolorosos. Este estudo teve como objetivo comparar as combinações de propofol-alfentanil e propofol-fentanil para sedação e analgesia em pacientes submetidos à colonoscopia eletiva. MÉTODOS: Estudo prospectivo e randomizado. Participaram do estudo 80 pacientes, ASA I-II, entre 18 e 65 anos. A indução de sedação e a analgesia foram feitas com propofol (1 mg.kg-1) e fentanil (1 µg.kg-1) no grupo propofol-fentanil (PF) e com propofol (1 mg.kg-1) e alfentanil (10 µg.kg-1) no grupo propofol-alfentanil (PA). Para manutenção, doses adicionais de propofol foram administradas em bolus de 0,5 mg.kg-1 para obter escores de 3-4 na Escala de Sedação de Ramsey (ESR). Registrados os dados demográficos, a frequência cardíaca, a pressão arterial média (PAM), a saturação de oxigênio da hemoglobina (SpO2), os valores da ESR, o tempo de colonoscopia, a dose total de propofol, as complicações, o tempo de recuperação e o tempo para alta, bem como os escores de satisfação do colonoscopista e do paciente. RESULTADOS: A PAM aos 15 minutos no Grupo PA foi significativamente maior do que no Grupo PF (p = 0,037). A frequência cardíaca média do grupo PA foi maior no início do que nas mensurações subsequentes (p = 0,012, p = 0,002). A média da dose total de propofol do Grupo PA foi significativamente maior do que a do Grupo PF (p = 0,028). O tempo médio de recuperação do grupo PA foi significativamente maior do que o do grupo PF (p = 0,032). CONCLUSÃO: Fentanil proporciona melhores condições de operação e reduz a necessidade de doses adicionais de propofol. Essas vantagens diminuem o tempo de recuperação. Portanto, propofol-fentanil é superior ao propofol-alfentanil para sedação e analgesia em colonoscopia.

Palavras-chave

ANALGÉSICOS, Opióides, fentanil, alfentanil, ANESTÉSICOS, Venoso, propofol, CIRURGIA, Endoscopia, Colonoscopia

Abstract

BACKGROUND AND OBJECTIVES: Sedation-analgesia is recommended for comfortable colonoscopy procedures, which are invasive and can be painful. This study aimed to compare the combinations of propofol-alfentanil and propofol-fentanyl for sedation-analgesia in elective colonoscopy patients. METHODS: This prospective and randomized study was planned in ASA I-II groups and included 80 patients between the ages of 18 and 65 years. Sedation-analgesia induction was performed as 1 µg.kg-1 fentanyl, 1 mg.kg-1 propofol in the propofol-fentanyl group (Group PF) and 10 µg.kg-1 alfentanil, 1 mg.kg-1 propofol in the propofol-alfentanil group (Group PA). Patients' scores were limited to 3-4 values on the Ramsey Sedation Scale (RSS) by 0.5 mg.kg-1 bolus additional doses of propofol in sedation-analgesia maintenance. We recorded demographical data, heart rate, mean arterial pressure (MAP), oxygen saturation of hemoglobin (SpO2), RSS value, colonoscopy time, total dose of propofol, complications, recovery time, and discharge time, as well as colonoscopist and patient satisfaction scores. RESULTS: MAP at the 15th minute in Group PA was significantly higher than in Group PF (p = 0.037). Group PA's beginning mean heart rate was higher than the mean heart rate at subsequent readings (p = 0.012, p = 0.002). The mean total propofol dose of Group PA was significantly higher than the total dose of Group PF (p = 0.028). The mean recovery time of Group PA was significantly longer than that of Group PF (p = 0.032). CONCLUSION: Fentanyl provides better operative conditions and reduces the need for additional propofol doses. These advantages cause a shorter recovery time. Therefore, propofol-fentanyl is superior to the propofol-alfentanil for sedation-analgesia in colonoscopy.

Keywords

Alfentanil, Colonoscopy, Fentanyl, Propofol

References

Runza M. Which type of sedation should be the target goal for use in colorectal endoscopic screening?. Minerva Anestesiol.. 2009;75(12):673-674.

Fanti L, Agostoni M, Gemma M. Sedation and monitoring for gastrointestinal endoscopy: a nationwide web survey in Italy. Dig Liver Dis. 2011;43(9):726-730.

Demiraran Y, Tamer A, Korkut E. Comparison of the sedative effects of dexmedetomidine and midazolam in cases undergoing colonoscopy. Endoscopy. 2009;17(1):18-22.

Madan A, Minocha A. Who is willing to undergo endoscopy without sedation: patients, nurses, or the physicians?. South Med J. 2004;97:800-805.

Lazzaroni M, Bianchi-Porro G. Premedication, preparation, and surveillance. Endoscopy. 1999;31:2-8.

Sporea I, Popescu A, Sandesc D, Salha CA, Sirli R, Danila M. Sedation during colonoscopy. Rom J Gastroenterol. 2005;14(2):195-198.

Dal H, İzdeş S, Kesimci E, Kanbak O. Intermittent bolus vs target controlled infusion of Propofol sedation for colonoscopy. JTAICS. 2011;39(3):134-142.

Jabbour-Khoury SI, Dabbous AS, Rizk LB. A combination of alfentanil-lidocaine-propofol provides better intubating conditions than fentanyl-lidocaine-propofol in the absence of muscle relaxants. Can J Anaesth. 2003;50(2):116-120.

Heiman DR, Tolliver BA, Weis FR, O'Brien BL, Di Palma JA. Patient-controlled anesthesia for colonoscopy using propofol: results of a pilot study. South Med J. 1998;91(6):560-564.

Di Palma JA, Herrera JL, Weis FR, Dark-Mezick DL, Brown RS. Alfentanil for conscious sedation during colonoscopy. South Med J. 1995;88(6):630-634.

Lee . The safety, feasibility, and acceptability of patient-controlled sedation for colonoscopy: prospective study. Hong Kong Med J. 2004;10:84-88.

Avramov MN, White PF. Use of alfentanil and propofol for outpatient monitored anesthesia care: determining the optimal dosing regimen. Anesth Analg. 1997;85(3):566-572.

Usta B, Türkay C, Muslu B, Gözdemir M, Kasapoglu B, Sert H. Patient-controlled analgesia and sedation with alfentanyl versus fentanyl for colonoscopy: a randomized double blind study. J Clin Gastroenterol. 2011;45(7):72-75.

Roseveare C, Seavell C, Patel P, Criswell J, Shepherd H. Patient-controlled sedation with propofol and alfentanil during colonoscopy: a pilot study. Endoscopy. 1998;30(5):482-483.

Külling D, Fantin AC, Biro P, Bauerfeind P, Fried M. Safer colonoscopy with patient-controlled analgesia and sedation with propofol and alfentanil. Gastrointest Endosc. 2001;54(1):1-7.

Chokhavatia S, Nguyen L, Williams R, Kao J, Heavner JE. Sedation and analgesia for gastrointestinal endoscopy. Am J Gastroenterol. 1993;88(3):393-396.

Holloway AM, Logan DA. Pain relief for outpatient colonoscopy: a comparison of alfentanil with fentanyl. Anaesth Intensive Care. 1990;18(2):210-213.

Consales G, Chelazzi C, Rinaldi S, De Gaudio AR. Bispectral Index compared to Ramsay score forsedation monitoring in intensive care units. Minerva Anestesiol. 2006;72:329-336.

Weatherburn C, Endacott R, Tynan P, Bailey M. The impact of bispectral index monitoring on sedation administration in mechanically ventilated patients. Anaesth Intensive Care. 2007;35:204-208.

Mondello E, Siliotti R, Noto G, Cuzzocrea E, Scollo G, Trimarchi G. Bispectral Index in ICU: correlation with Ramsay Score on assessment of sedation level. J Clin Monit Comput. 2002;17:271-277.

Toklu S, Iyilikci L, Gonen C, Ciftci L, Gunenc F, Sahin E, Gokel E. Comparison of etomidate-remifentanil and propofol-remifentanil sedation in patients scheduled for colonoscopy. Eur J Anaesthesiol. 2009;26(5):370-376.

5dd401590e8825e41dc63493 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections