title: Remifentanil vs. meperidine for patient-controlled analgesia during colonoscopy: a randomized double-blind trial.
abstract: OBJECTIVE
  The aim was to compare patients' and endoscopists' satisfaction in terms of efficacy and safety of remifentanil patient-controlled analgesia (PCA) during colonoscopy with that of a combination of midazolam and meperidine.
  
  
  METHODS
  Sixty patients undergoing colonoscopy were randomly assigned to two groups. All of the patients received midazolam 0.03 mg/kg intravenously for premedication. In the remifentanil group, a bolus dose of remifentanil was given, and a patient-controlled sedation analgesia (PCSA) pump was set to inject further bolus doses with no "lockout" time. Patients in the meperidine group received a bolus of meperidine and sham PCSA. Non-invasive arterial blood pressure, electrocardiography, and pulse oximetry were monitored throughout the study. The Observer's Assessment of Alertness and Sedation Scale (OAA/S) was performed at baseline, every 5 min during, and after colonoscopy. Assessment of pain and satisfaction with sedoanalgesia was scheduled after colonoscopy and 24-72 h later by a 100 mm visual analog scale (VAS). The technical difficulty of the examination and the gastroenterologist's satisfaction were assessed similarly.
  
  
  RESULTS
  The degree of pain, the level of satisfaction with sedoanalgesia by patients and gastroenterologists, and the degree of difficulty experienced by the endoscopist were not different in the two groups. The time to reach an Aldrete score > or = 9 was significantly shorter in the remifentanil group (P < 0.0001); discharge times did not differ between the groups (P = 0.36). There was no difference between the groups regarding the duration of colonoscopy (P = 0.82) and the stability of vital signs. At the end of the procedure, OAA/S was significantly higher in the remifentanil group (P = 0.03).
  
  
  CONCLUSIONS
  Remifentanil PCA is safe and effective to induce sedoanalgesia during colonoscopy. Further studies should address the optimization of dosing and lock out setting.
authors.affiliation: Department of Gastroenterology, Vita-Salute University of Milano, IRCCS H. San Raffaele, Milano, Italy. fanti.lorella@hsr.it
authors.forename: Lorella
authors.initials: L
authors.lastname: Fanti
authors.forename: Massimo
authors.initials: M
authors.lastname: Agostoni
authors.forename: Agostoni
authors.initials: A
authors.lastname: Massimo
authors.forename: Marco
authors.initials: M
authors.lastname: Gemma
authors.forename: Gemma
authors.initials: G
authors.lastname: Marco
authors.forename: Giulia
authors.initials: G
authors.lastname: Gambino
authors.forename: Gambino
authors.initials: G
authors.lastname: Giulia
authors.forename: Antonio
authors.initials: A
authors.lastname: Facciorusso
authors.forename: Facciorusso
authors.initials: F
authors.lastname: Antonio
authors.forename: Mario
authors.initials: M
authors.lastname: Guslandi
authors.forename: Guslandi
authors.initials: G
authors.lastname: Mario
authors.forename: Giorgio
authors.initials: G
authors.lastname: Torri
authors.forename: Torri
authors.initials: T
authors.lastname: Giorgio
authors.forename: Pier Alberto
authors.initials: PA
authors.lastname: Testoni
authors.forename: Testoni Pier
authors.initials: TP
authors.lastname: Alberto