The comparison of sedation quality, side effect and recovery profiles on different dosage of remifentanil patient-controlled sedation during breast biopsy surgery

Abstract

Background: The patient-controlled sedation (PCS) allows for rapid individualized titration of sedative drugs. Propofol has been the most widely used IV adjuvant, during the monitored anesthesia care (MAC). This study was designed to compare the sedation quality, side effect and recovery of the propofol alone, and propofol-remifentanil combination, using PCS for breast biopsy.

Methods: Seventy five outpatients, undergoing breast biopsy procedures with local anesthesia, were randomly assigned to receive propofol alone (group P), propofol-25 ug/ml of remifentanil (group PR25), and propofol-50 ug/ml of remifentanil (group PR50), using PCS. Pain visual analogue scores (VAS) and digit symbol substitution test (DSST), Vital signs, bi-spectral index (BIS) and observer assessment of alertness and sedation (OAA/S) score were recorded.

Results: Apply/Demand ratio in the group PR50 had a significant increase over the other groups (P < 0.05). The incidence of excessive sedation and dizziness were significantly more frequent in the group PR50 (P < 0.05). BIS and OAA/S score significantly decreased in the group PR25, PR50 at 15 min after the operation, the end of surgery (P < 0.05). At 5 min after the start of PCS, patients in the group PR25 and PR50 gave significantly less correct responses on the DSST than that of the group P (P < 0.05).

Conclusions: Compared with the propofol alone, intermittent bolus injection of propofol-remifentanil mixture could be used, appropriately, for the sedation and analgesia during MAC. The group PR25 in a low dose of remifentanil has more advantages in terms of sedation and satisfaction because of the group PR50's side effects.

Keywords: Monitored anesthesia care; Patient-controlled sedation; Propofol; Remifentanil.

Fig. 1

Changes in pain visual analogue scale (VAS) scores, bispectral (BIS) values, observer assessment of alertness/sedation (OAA/S) scores for the three PCS group. P group: propofol alone group, PR25 group: propofol-remifentanil (25 ug/ml) group, PR50 group: propofol-remifentanil (50 ug/ml) group. B: baseline, PCS5: 5 min after PCS start, Inc: just after incision, OP15: 15 min after incision, OPend: the end of surgery, R0: just after arrival at recovery room, R15: 15 min after arrival at recovery room, R30: 30 min after arrival at recovery room. ^*P < 0.05, significantly different from P group value alone. ^†P < 0.05, significantly different from other groups value. Data are expressed as mean ± SD.

Fig. 2

The number of symbols correctly dawn on the digit symbol substitution test (DSST) for the three PCS group. P group: propofol alone group, PR25 group: propofol-remifentanil (25 ug/ml) group, PR50 group: propofol-remifentanil (50 ug/ml) group. B: baseline, PCS5: 5 min after PCS start, R0: just after arrival at recovery room, R15: 15 min after arrival at recovery room, R30: 30 min after arrival at recovery room.^*P < 0.05, significantly different from P group value. ^†P < 0.05, significantly different from other groups value. Data are expressed as mean ± SD.