A comparison of propofol and remifentanil during monitored anesthesia care.
OBJECTIVE
To compare remifentanil, an esterase-metabolized opioid, to a standard propofol-based sedation technique for monitored anesthesia care (MAC).


METHODS
Non-randomized, open label.


METHODS
University hospital.


METHODS
44 healthy female outpatients undergoing breast biopsy procedures under local anesthesia.


METHODS
All patients received intravenous (IV) midazolam 2 mg, followed by a continuous infusion of either propofol 75 micrograms/kg/min, or remifentanil 0.1 microgram/kg/min, which was subsequently titrated to maintain optimal patient comfort without respiratory depression. Surgical-related pain was treated by injecting additional local anesthetic solution and "rescue" boluses of fentanyl 25 micrograms IV.


RESULTS
Sedation, pain, and discomfort were monitored using standardized rating scales at 1 to 5 minute intervals. Recovery times were measured from the end of the study drug infusions. Propofol resulted in significantly higher median sedation scores compared with remifentanil, with 73% of patients requiring a decrease in the propofol infusion rate because of "excessive" sedation. Local anesthetic requirements, pain, and discomfort scores during surgery were similar in both groups. Remifentanil resulted in greater respiratory depression compared with propofol, with decreases in the remifentanil infusion rate required by 41% of patients because of a slow respiratory rate (< 8 bpm) and/or oxygen desaturation measured by pulse oximetry (SpO2 < 90%). Median times to ambulation and to being judged "fit for discharge" were significantly shorter following propofol (40 and 47 minutes, respectively) compared with remifentanil (52 and 58 minutes, respectively).


CONCLUSIONS
Remifentanil provided comparable intraoperative conditions and patient comfort at a lower sedation level compared with propofol. However, remifentanil was associated with greater respiratory depression and a longer time to home readiness.
Smith
I
I
Department of Anesthesiology and Pain Management, University of Texas South-western Medical Center at Dallas 75235-9068, USA.
Avramov
M N
MN
White
P F
PF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000772:Anesthesia, Local / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D000779:Anesthetics, Local; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008012:Lidocaine; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010100:Oxygen / Q000097:blood; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D010880:Piperidines / Q000009:adverse effects; D015742:Propofol / Q000009:adverse effects; D000077208:Remifentanil
D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D010880:Piperidines; D008012:Lidocaine; D000077208:Remifentanil; D010100:Oxygen; D015742:Propofol