Remifentanil or propofol for sedation during carotid endarterectomy under cervical plexus block.
BACKGROUND
During carotid endarterectomy under regional anaesthesia, patients often require medication to control haemodynamic instability and to provide sedation and analgesia. Propofol and remifentanil are used for this purpose. However, the benefits, side-effects, and optimal dose of these drugs in such patients are unclear.


METHODS
Sixty patients were included in a prospective, randomized, single blinded study. All patients received a deep cervical plexus block with 30 ml ropivacaine 0.75% and were randomized to receive either remifentanil 3 micro g kg(-1) h(-1) or propofol 1 mg kg(-1) h(-1). The infusions were started after performing the regional block and were stopped at the end of surgery. Arterial pressure, ECG, ventilatory rate, and Pa(CO(2)) were measured continuously and recorded at predetermined times. Twenty-four hours after surgery, patient comfort, and satisfaction were also evaluated.


RESULTS
In three patients, the infusion of remifentanil had to be stopped because of severe respiratory depression or bradycardia. No significant differences were found between the two groups in haemodynamic variables or sedative effects, but there was a significantly greater decrease in ventilatory frequency and increase in Pa(CO(2)) in the remifentanil group. The patient's subjective impressions and pain control were excellent in both groups.


CONCLUSIONS
As a result of the higher incidence of adverse respiratory effects with remifentanil and similar sedative effects, propofol is preferable for sedation during cervical plexus block in elderly patients with comorbid disease at the dosage used.
Krenn
H
H
Department of Anaesthesia and Intensive Care, City of Vienna Hospital Lainz, A-1130 Vienna, Austria.
Deusch
E
E
Jellinek
H
H
Oczenski
W
W
Fitzgerald
R D
RD
D000368:Aged; D000369:Aged, 80 and over; D018686:Anesthetics, Intravenous; D002572:Cervical Plexus; D016292:Procedural Sedation / Q000379:methods*; D016894:Endarterectomy, Carotid; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D008875:Middle Aged; D009407:Nerve Block; D010880:Piperidines / Q000009:adverse effects; D015742:Propofol; D011446:Prospective Studies; D000077208:Remifentanil; D012131:Respiratory Insufficiency / Q000139:chemically induced; D016037:Single-Blind Method
D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol