title: An evaluation of conscious sedation using propofol and remifentanil for tension-free vaginal tape insertion.
abstract: Tension-free vaginal tape insertion is a recommended treatment for stress incontinence. There is evidence that intra-operative testing of continence by asking patients to cough may improve outcomes, but an optimal sedation regimen has not been determined. We prospectively evaluated the effectiveness of propofol and remifentanil infusions in 25 patients using pre- and post-sedation peak cough pressures and pain scores. Patient satisfaction was assessed using the Iowa Satisfaction with Anaesthesia Score (ISAS). Post-sedation cough pressures were improved compared to baseline, with a mean peak pressure increase of 24 mmHg (95% CI 15.5-32.5; p < 0.001). Pain scores (median, IQR [range]) were low for local anaesthetic infiltration (0, [0-1]) and first (0, [0-1]) and second (0, [0-3.5]) needle insertions. Of the 19 patients completing the ISAS, all felt safe and satisfied. Sedation using propofol and remifentanil provides acceptable analgesia, satisfaction and effective continence testing.
authors.affiliation: Lincoln County Hospital, Lincolnshire, UK.
authors.forename: A L
authors.initials: AL
authors.lastname: Winton
authors.forename: J
authors.initials: J
authors.lastname: Eastwood
authors.forename: M C
authors.initials: MC
authors.lastname: Powell
authors.forename: A M
authors.initials: AM
authors.lastname: Norris
mesh_terms: D000328:Adult; D016292:Procedural Sedation / Q000379:methods*; D003371:Cough / Q000150:complications; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D007430:Intraoperative Care / Q000379:methods; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D017060:Patient Satisfaction; D010880:Piperidines; D015742:Propofol; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods; D000077208:Remifentanil; D053825:Suburethral Slings; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000601:surgery*
chemical_list: D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol