title: Remifentanil for the insertion and removal of long-term central venous access during monitored anesthesia care.
abstract: OBJECTIVE
  To determine the analgesic efficacy of three different rates of remifentanil infusion in patients undergoing insertion or removal of long-term central venous access devices during monitored anesthesia care and local anesthetic field infiltration.
  
  
  METHODS
  Double-blinded, randomized, controlled study.
  
  
  METHODS
  Operating theatre of an University hospital.
  
  
  METHODS
  44 unpremedicated, ASA physical status 1 and 2 patients, aged 18-65 years, undergoing insertion or removal of a Port-a-Cath or Hickman catheter.
  
  
  METHODS
  Patients sedated with a propofol target-controlled infusion were randomly allocated to three groups: Group R25 (n = 14), Group R50 (n = 15), and Group R75 (n = 15), to receive remifentanil 0.025, 0.05, and 0.075 μg/kg/min, respectively. Rescue remifentanil 0.5 μg/kg was administered for pain scores > 3. The remifentanil infusion rate was maintained constant unless respiratory and/or cardiovascular unwanted events occurred, whereupon the rate was adjusted in 0.01 μg/kg/min decrements as necessary.
  
  
  METHODS
  Pain scores (primary outcome), sedation, and movement scores (secondary outcomes) were assessed during local anesthetic infiltration of the anterior chest wall and 5 other procedural steps.
  
  
  RESULTS
  All infusion rates had equal analgesic efficacy, as shown by comparable pain scores, number of rescue boluses, and number of patients requiring rescue analgesia. Excessive sedation was associated with the highest remifentanil rate such that Group R75 patients were significantly more sedated than Groups R25 or R50 at selective procedural steps (P < 0.05). More Group R75 patients (6/15) required remifentanil rate reduction than did patients from Group R50 (1/15) or Group R25 (0/14), P < 0.01, most commonly because of respiratory depression.
  
  
  CONCLUSIONS
  For the insertion or removal of long-term central venous access devices, all three remifentanil infusion rates proved to be equally analgesic-efficient. However, the excessive sedation and tendency to respiratory and cardiovascular events associated with the highest remifentanil infusion rate renders such a rate less desirable for this purpose.
authors.affiliation: Department of Anesthesia, Intensive Care and Pain Medicine, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. crina@ireland.com
authors.forename: Crina L
authors.initials: CL
authors.lastname: Burlacu
authors.forename: Kevin
authors.initials: K
authors.lastname: McKeating
authors.forename: Alan J
authors.initials: AJ
authors.lastname: McShane
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use; D002405:Catheterization, Central Venous / Q000379:methods*; D002408:Catheters, Indwelling; D020878:Device Removal; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015742:Propofol / Q000008:administration & dosage / Q000627:therapeutic use; D011446:Prospective Studies; D000077208:Remifentanil; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol