Total intravenous anesthesia using remifentanil in extracorporeal shock wave
lithotripsy (ESWL). Comparison of two dosages: a randomized clinical trial.
Author(s): Cannata F(1), Spinoglio A, Di Marco P, Luzi M, Canneti A, Ricciuti G, Reale C.
Affiliation(s): Author information:
(1)Department of Anesthesiology, Pain Medicine and Critical Care, "Sapienza"
University, Rome, Italy - francesco.cannata@uniroma1.it.
Publication date & source: 2014, Minerva Anestesiol. , 80(1):58-65
BACKGROUND: Extracorporeal Shock Wave Lithotripsy is usually performed in day
surgery setting, consequently people who undergo to this procedure need a safe
and fast recovery. Conscious sedation with remifentanil can relieve from pain and
keep patients in touch with anaesthesiologists. Few publications tell about
infusion rates administered to perform this procedure7. The aim of this study is
to assess which is the most appropriate infusion rate.
METHODS: Patients were randomly assigned to two groups. Two different infusion
rates were compared: 0,05 mcg/kg/min, GROUP A (N.=114), vs. 0.1 µg/kg/min, GROUP
B (N.=114). Patients' vital signs, additional analgesic requests, PONV
(postoperative nausea and vomiting) and other side effects were registered. The
deepness of sedation and patient's satisfaction were evaluated referring to
Obsever's Assessment of Alertness and Sedation scale (O/ASS) and using a Likert's
scale respectively. Pain intensity was assessed with a 11-points VAS (visual
analogue scale). Differences between groups were analyzed using Student t test
for independent variables. The χ2 test was used to analyze categorical variables.
RESULTS: The study enrolled 228 patients and assigned them to two groups
(N.=114). No significant differences were found regarding Likert's scale values
(P=0.20), additional analgesic request (P=0.30) and mean VAS values (P>0.05)
between the two groups. The difference between the two groups about PONV,
hypotension, oxygen desaturation and respiratory depression was statistically
significant (P<0.05), as a matter of fact in group A these side effects occurred
less frequently. The fifth degree of O/ASS was estimated in about 1.61±0.19 min
and 2.987±0.20 min in group A and in group B respectively (P<0.05).
CONCLUSION: According with previous results remifentanil at the infusion rate of
0.05 µg/kg/min provides an effective analgesia, causing a lower incidence of side
effect than 0.1 µg/kg/min, granting a fast and safe recovery.
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