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Le rémifentanil est une alternative efficace au propofol pour l’analgésie auto-contrôlée en endoscopie digestive

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

Du Service d’Anesthésie-Réanimation, Hôtel-Dieu, Lyon, France.

Adresser la correspondance à : Dr Emmanuel Boselli, Service d’Anesthésie-Réanimation, Hôtel-Dieu, 1 place de l’hôpital, 69288 Lyon cedex 02, France. Téléphone : +33 472 413 170 ; Télécopieur : +33 472 413 135 ; Courriel : emmanuel.boselli{at}chu-lyon.fr

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 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.

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.

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