Remifentanil conscious sedation during regional anaesthesia for carotid endarterectomy: rationale and safety.
OBJECTIVE
to prospectively evaluate the safety and efficacy of remifentanil during regional anaesthesia for carotid endarterectomy.


METHODS
twenty-eight consecutive patients underwent carotid endarterectomy with combined superficial and deep cervical plexus block supplemented with continuous intravenous 0.04 microg.kg(-1).min(-1)remifentanil infusion. Depth of sedation was monitored using the Observer's Assessment of Alertness/Sedation Scale (OAA/S). The degree of pain, discomfort and anxiety was self-assessed by the patients using a horizontal visual analogue scale.


RESULTS
all patients experienced adequate comfort and analgesia. No local anaesthetic supplementation was necessary. No patient had a OAA/S score lower than 4 (with 5=awake/alert to 1=asleep). Respiratory depression did not occur. Selective shunting was required in four cases. No patient was converted to general anaesthesia. There were no permanent neurological deficits, cardiopulmonary complications or deaths.


CONCLUSIONS
remifentanil as a supplement to regional anaesthesia for carotid endarterectomy, provides comfort and analgesia without hampering mental status evaluation.
Marrocco-Trischitta
M M
MM
Department of Vascular Surgery and Pathology, Istituto Dermopatico dell Immacolata, I.D.I.-IRCCS, Via dei Monti di Creta, 104, 10067 Rome, Italy.
Bandiera
G
G
Camilli
S
S
Stillo
F
F
Cirielli
C
C
Guerrini
P
P
D000368:Aged; D000369:Aged, 80 and over; D000765:Anesthesia, Conduction; D016292:Procedural Sedation / Q000379:methods*; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010880:Piperidines / Q000008:administration & dosage*; D011446:Prospective Studies; D000077208:Remifentanil; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil