Remifentanil for use during conscious sedation in outpatient oral surgery.
OBJECTIVE
Remifentanil is a new, short-acting opioid that is similar pharmacodynamically to currently available opioids but differs in its pharmacokinetics. In the present study, we compared the use of remifentanil with the use of meperidine during intravenous conscious sedation for third molar surgery.


METHODS
Forty patients who were scheduled for the removal of impacted third molars were randomly assigned to undergo 1 of 2 intravenous conscious sedation techniques. For both groups, 50:50 nitrous oxide oxygen were administered via nasal hood, and midazolam was titrated to Verril's sign. Twenty patients each then received either remifentanil 0.05 microgram/kg/min or meperidine 50 mg. Both patients and surgeons were blinded to the narcotic that was used. Blood pressure, heart rate, and oxygen saturation were determined before sedation and every 5 minutes during surgery. Recovery was measured using serial Trieger tests every 5 minutes after surgery. Patient and surgeon satisfaction of the quality of sedation was measured with a visual analog scale.


RESULTS
Peak heart rate (91 beats/min for remifentanil vs 107 beats/min for meperidine, P <.01) and peak systolic blood pressure (131 mm Hg for remifentanil vs. 142 mm Hg for meperidine, P <.05) were significantly lower for the remifentanil group. Although there was a trend toward increased surgeon satisfaction with remifentanil (86 of 100 with remifentanil vs. 73 of 100 with meperidine), it was not found to be statistically significant. Likewise, other physiologic parameters were not found to be statistically significant.


CONCLUSIONS
The lower peak heart rate and systolic blood pressure levels indicate that remifentanil may allow for less fluctuation in cardiovascular parameters. This could prove beneficial in patients with cardiovascular compromise.
Ganzberg
Steven
S
Department of Oral and Maxillofacial Surgery, Pathology and Anesthesiology, College of Dentistry, The Ohio State University, Columbus, OH 43218-2357, USA.
Pape
Richard A
RA
Beck
F Michael
FM
D000293:Adolescent; D000328:Adult; D000556:Ambulatory Surgical Procedures; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000766:Anesthesia, Dental / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D016009:Chi-Square Distribution; D016292:Procedural Sedation / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008614:Meperidine / Q000008:administration & dosage; D008874:Midazolam / Q000008:administration & dosage; D008964:Molar, Third / Q000601:surgery; D017060:Patient Satisfaction; D010880:Piperidines / Q000008:administration & dosage*; D000077208:Remifentanil; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014081:Tooth Extraction
D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D010880:Piperidines; D008614:Meperidine; D000077208:Remifentanil; D008874:Midazolam