[Sedoanalgesia with remifentanil in definitive pacemaker implant].
OBJECTIVE
Describe the use of remifentanil in definitive pacemaker implant.


METHODS
Prospective, observational study.


METHODS
Intensive Care Unit of two general hospitals.


METHODS
Ninety-four patients subjected to DPM implant under sedation with remifentanil.


METHODS
The protocol for DPM implant was conducted: premedication with metoclopramide, remifentanil perfusion (20 micro g/ml), local infiltration with mepivacaine 2%, administration of magnesium metamizole at the end of the implant and posterior discontinuation of remifentanil. Remifentanil perfusion was initiated at 2 micro g/minute, increasing it until reaching a sedation grade 2-3 on the Ramsay scale, with a maximum of 6 micro g/minute. MAIN ENDPOINTS: Time needed to reach the desired sedation grade and duration of sedation, maximum dose of remifentanil necessary, frequency that another sedation was needed and of adverse events were recorded. Continuous quantitative endpoints were expressed as mean +/- SD.


RESULTS
A sedation grade 2-3 was achieved with a perfusion rhythm of 3.6 +/- 1.4 micro g/min, in 20 +/- 22 minutes. In 89 patients (94.6%), the implant was performed only with remifentanil. Frequency of adverse events were nauseas/vomiting 21.3%, hypotension 5.3% and respiratory depression 1%. Remifentanil perfusion was discontinued in 3 patients (3.2%) due to appearance of adverse events. Another sedoanalgesic was used in 2 patients (2.1%).


CONCLUSIONS
Remifentanil is useful in the implant of DPM as a sedoanalgesia method. Serious undesired effects are rare. Future studies are necessary to completely establish its effectiveness and safety in these types of procedures.
Blancas Gómez-Casero
R
R
Unidad de Cuidados Intensivos, Hospital General La Mancha-Centro, Alcázar de San Juan, Ciudad Real, España. rblancasg@sescam.jccm.es
Martín Delgado
C
C
Nevado Losada
E
E
Quintana Díaz
M
M
Chana García
M
M
López Matamala
B
B
Serrano Castañeda
J
J
González Manzanares
J L
JL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D002304:Cardiac Pacing, Artificial; D006348:Cardiac Surgical Procedures / Q000379:methods; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D010880:Piperidines / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D000077208:Remifentanil
D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil