title: Target-controlled infusion of remifentanil with or without flurbiprofen axetil in sedation for extracorporeal shock wave lithotripsy of pancreatic stones: a prospective, open-label, randomized controlled trial.
abstract: BACKGROUND
  Extracorporeal shock wave lithotripsy (ESWL) is an effective therapeutic method used to treat patients with pancreatic stones. However, the anesthesia for this procedure has been underappreciated, with minimal reports of these procedures in certain case series with general or epidural anesthesia.
  
  
  METHODS
  A cohort of 60 patients who elected to undergo ESWL in order to treat pancreatic stones for the first time were randomly selected and divided into two groups. One group of patients received target controlled infusion (TCI) of remifentanil, while the other group of patients received TCI of remifentanil plus a bolus of flurbiprofen axetil (a cyclooxygenase inhibitor) (Rem group and Rem + Flu group, n = 30 for each group). The Dixon's up-and-down method was used to calculate the half maximum effective concentration (EC50) of remifentanil. Visual analogue scales of pain, Ramsay sedation scale, hemodynamic changes, and adverse events were also recorded.
  
  
  RESULTS
  The EC50 of remifentanil was calculated to be 4.0 ng/ml (95 % confidential interval: 3.84 ng/ml, 4.16 ng/ml) and 2.76 ng/ml (95 % confidential interval: 2.63 ng/ml, 2.89 ng/ml) in the Rem group and Rem + Flu group respectively (p < 0.001). Pain score was comparable between the two groups, while the Ramsay sedation scale was higher in the Rem group. Hemodynamic data showed that patients in the Rem group experienced higher mean arterial pressures and higher heart rates across the procedures. Patients in Rem group demonstrated a lower respiratory rate (p < 0.001) and a lower SpO2 (p = 0.001). Less adverse events occurred in Rem + Flu group, including a reduced respiratory depression requiring wake-up as well as reduced postoperative nausea and vomiting.
  
  
  CONCLUSIONS
  Remifentanil plus flurbiprofen axetil provided satisfactory analgesia and sedation for ESWL of pancreatic stones with less adverse events. (Clinicaltrial.gov: NCT01998217 ; registered on November 19, 2013).
authors.affiliation: Department of Anesthesiology and Intensive Care, Changhai Hospital, the Second Military Medical University, 168 Changhai Road, Shanghai, 200433, PR China.
authors.forename: Yu-Guang
authors.initials: YG
authors.lastname: Yang
authors.affiliation: Department of Gastroenterology, Changhai Hospital, the Second Military Medical University, Shanghai, 200433, PR China.
authors.forename: Liang-Hao
authors.initials: LH
authors.lastname: Hu
authors.affiliation: Department of Anesthesiology and Intensive Care, Changhai Hospital, the Second Military Medical University, 168 Changhai Road, Shanghai, 200433, PR China.
authors.forename: Hui
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Anesthesiology and Intensive Care, Changhai Hospital, the Second Military Medical University, 168 Changhai Road, Shanghai, 200433, PR China.
authors.forename: Bo
authors.initials: B
authors.lastname: Li
authors.affiliation: Department of Anesthesiology and Intensive Care, Changhai Hospital, the Second Military Medical University, 168 Changhai Road, Shanghai, 200433, PR China.
authors.forename: Xiao-Hua
authors.initials: XH
authors.lastname: Fan
authors.affiliation: Department of Anesthesiology and Intensive Care, Changhai Hospital, the Second Military Medical University, 168 Changhai Road, Shanghai, 200433, PR China.
authors.forename: Jin-Bao
authors.initials: JB
authors.lastname: Li
authors.affiliation: Department of Anesthesiology and Intensive Care, Changhai Hospital, the Second Military Medical University, 168 Changhai Road, Shanghai, 200433, PR China. jfwang@smmu.edu.cn.
authors.forename: Jia-Feng
authors.initials: JF
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology and Intensive Care, Changhai Hospital, the Second Military Medical University, 168 Changhai Road, Shanghai, 200433, PR China. deng_x@yahoo.com.
authors.forename: Xiao-Ming
authors.initials: XM
authors.lastname: Deng
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects; D062186:Arterial Pressure / Q000187:drug effects; D002137:Calculi / Q000473:pathology / Q000628:therapy*; D004359:Drug Therapy, Combination; D005260:Female; D005480:Flurbiprofen / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010182:Pancreatic Diseases / Q000473:pathology / Q000628:therapy; D010880:Piperidines / Q000008:administration & dosage* / Q000009:adverse effects; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011446:Prospective Studies; D000077208:Remifentanil; D056152:Respiratory Rate / Q000187:drug effects
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D006993:Hypnotics and Sedatives; D010880:Piperidines; D005480:Flurbiprofen; C504422:flurbiprofen axetil; D000077208:Remifentanil