title: Improved sedation with dexmedetomidine-remifentanil compared with midazolam-remifentanil during catheter ablation of atrial fibrillation: a randomized, controlled trial.
abstract: OBJECTIVE
  Anaesthesia is required for catheter ablation of atrial fibrillation (A-fib) to achieve patient comfort and immobilization to avoid map shifts. This study compared the analgesic and sedative efficacies of dexmedetomidine-remifentanil with those of midazolam-remifentanil for catheter ablation of A-fib.
  
  
  RESULTS
  Ninety patients were randomized to receive either intermittent midazolam boluses (1-2 mg) with 3.6-7.2 µg/kg/h of remifentanil (MR group) or dexmedetomidine 0.2-0.7 µg/kg/h after a loading dose of 1 µg/kg with 1.2-2.4 µg/kg/h of remifentanil (DR group). The sedation level assessed by the Ramsay sedation and bispectral index scores, haemodynamic variables, pain score (10-point numerical scale), and satisfaction levels of the patients and cardiologists (5-point numerical scale) were recorded. The Ramsay sedation score was significantly higher, and the bispectral index score was lower in the DR group (P< 0.001) compared with the MR group starting 10 min after drug administration. The incidence of desaturation (SpO2 < 90%) was significantly greater in the MR group compared with the DR group (15 vs. 1, P < 0.001). The pain score was significantly lower (1.72 ± 1.65 vs. 0.95 ± 1.10, P = 0.021), and the satisfaction levels of interventionists were significantly higher (2.50 ± 0.71 vs. 3.00 ± 0.63, P = 0.001) in the DR group compared with the MR group.
  
  
  CONCLUSIONS
  The combination of dexmedetomidine and remifentanil provided deeper sedation, less respiratory depression, better analgesia, and higher satisfaction for the interventionist during catheter ablation of A-fib compared with midazolam plus remifentanil, even at a lower dose of remifentanil.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Jin Sun
authors.initials: JS
authors.lastname: Cho
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul 120-752, South Korea Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Jae-Kwang
authors.initials: JK
authors.lastname: Shim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul 120-752, South Korea Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Sungwon
authors.initials: S
authors.lastname: Na
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Inhye
authors.initials: I
authors.lastname: Park
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul 120-752, South Korea Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 120-752, South Korea Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul 120-752, South Korea ylkwak@yuhs.ac.
authors.forename: Young Lan
authors.initials: YL
authors.lastname: Kwak
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001291:Attitude of Health Personnel; D017115:Catheter Ablation / Q000009:adverse effects; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D056805:Consciousness Monitors; D020927:Dexmedetomidine / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D064795:Intraoperative Neurophysiological Monitoring / Q000295:instrumentation; D008297:Male; D008874:Midazolam / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D058748:Pain Perception / Q000187:drug effects; D017288:Pain Threshold / Q000187:drug effects; D017060:Patient Satisfaction; D010880:Piperidines / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D000077208:Remifentanil; D056910:Republic of Korea; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D010880:Piperidines; D020927:Dexmedetomidine; D000077208:Remifentanil; D008874:Midazolam
keywords: Atrial fibrillation; Catheter ablation; Conscious sedation; Dexmedetomidine; Midazolam; Remifentanil