[Sedation in spinal anesthesia. Comparison of remifentanil and propofol].
OBJECTIVE
To assess the efficacy and safety of remifentanil for analgesia and sedation during subarachnoidea anesthesia, and to compare remifentanil with propofol.


METHODS
Ninety ASA I-III patients undergoing orthopedic or traumatologic surgery under subarachnoid anesthesia were enrolled for prospective study and randomly assigned to two treatment groups. The propofol group (n = 45) received a single dose of 0.5 mg/kg followed by infusion at 3 mg/kg/h. The remifentanil group (n = 45) received a single dose of 0.5 microgram/kg followed by infusion at 0.1 microgram/kg/min. We evaluated quality of sedation, pain intensity during nerve blockade, hemodynamic and respiratory parameters and time until recovery.


RESULTS
The remifentanil group experienced less moderate-to-intense pain (13%) than did the propofol group (63%) (p < 0.01). Sedation was adequate in both groups and was easy to control by adjusting the rate of infusion. Times until recovery of consciousness and respiratory frequency after withdrawal of infusion until recovery of baseline levels were 7.87 +/- 3.54 min and 5.22 +/- 2.49 min, respectively, in the remifentanil group and 8.72 +/- 4.59 min and 5.36 +/- 2.49 min, respectively, in the propofol group, respectively. Patients in the remifentanil group experienced a significantly greater decrease in SpO2 than did those in the propofol group (20% and 4%, respectively; p < 0.05). Mean blood pressure was higher for patients treated with remifentanil. The incidence of vomiting was also higher in the remifentanil group than in the propofol group (9% vs 0%).


CONCLUSIONS
Remifentanil is more effective in reducing pain related to nerve blockade and level of sedation is lower; however remifentanil is associated with a higher incidence of respiratory depression and vomiting.
Gilabert Morell
A
A
Servicio de Anestesiología, Reanimación y Terapia del Dolor. Hospital General de Elda. Elda. Alicante.
Fernández Méndez
F
F
Berenguer Pellús
J
J
Sánchez Pérez
C
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000775:Anesthesia, Spinal; D018681:Anesthetics, General / Q000009:adverse effects; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D000860:Hypoxia / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D010149:Postoperative Pain / Q000188:drug therapy; D010880:Piperidines / Q000009:adverse effects; D015742:Propofol / Q000009:adverse effects; D011446:Prospective Studies; D000077208:Remifentanil; D012120:Respiration Disorders / Q000139:chemically induced; D012449:Safety; D014839:Vomiting / Q000139:chemically induced
D018681:Anesthetics, General; D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol