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Remifentanil versus propofol for radio frequency treatment of atrial flutter

[Rémifentanil versus propofol pour le traitement des flutters auriculaires par radiofréquences]

Pierre Lena, MD^*, Claude Jean Mariottini, MD^*, Nobert Balarac, MD^*, Jean Jacques Arnulf, MD^*, Alain Mihoubi, MD^* and René Martin, MD FRCP

^* From the Departments of Anesthesia and Cardiology, Institut Arnault Tzanck, Saint Laurent du Var, France; and the
Department of Anesthesiology, University of Sherbrooke, Sherbrooke, Québec, Canada.

Address correspondence to: Dr. Pierre Lena, Institut Arnault Tzanck, Saint Laurent du Var, France. E-mail: pierre.lena{at}wanadoo.fr

Purpose: Radio frequency treatment in cardiology generates short acute pain during the heating process. The present study evaluates two techniques used for sedation/analgesia for this procedure.

Methods: Two groups of 20 patients each were studied prospectively. Patients were randomized to receive sedation for the procedure using either a patient-controlled analgesia device with remifentanil (Group R), or a target controlled infusion of propofol (Group P). Patients in Group R had a basal infusion of remifentanil 0.02–0.04 µg·kg^–1·min^–1 with self administered bolus doses of 0.3 µg·kg^–1 iv every minute as required, with a delivery time greater than 30 sec. Patients in Group P had an initial plasma target concentration set at 3–4 µg·mL^–1

Results: Sedation scores were significantly higher in Group P, and two patients required supplementation with remifentanil and insertion of an laryngeal mask airway. Pain scores were higher in Group R, and two patients experienced muscular rigidity, one with transient apnea. Systolic blood pressure decreased significantly in Group P, and at the end of the procedure, PaCO₂ values were higher in that group (P < 0.01). Recovery time was significantly longer in Group P. Patient and physician satisfaction scores were similar in the two groups.

Conclusions: A basal infusion of remifentanil plus remifentanil patient controlled analgesia and target controlled infusion of propofol were adequate but not optimal techniques for sedation/analgesia for radio frequency treatment of atrial flutter.