Conscious sedation anesthesia using different doses of remifentanil combined with dexmedetomidine for peritoneal dialysis catheter implantation

Abstract

Background: Conscious sedation anesthesia (CSA) is an anesthetic method during peritoneal dialysis catheter implantation. However, lack of optimal CSA strategies for patients with end-stage renal disease (ESRD). This study aimed to evaluate the analgesic effects and safety of CSA using different doses of remifentanil combined with dexmedetomidine during peritoneal dialysis catheter insertion.

Methods: Patients who underwent peritoneal dialysis (PD) catheter placement via open surgical incision were retrospectively analyzed and divided into three groups based on the tertile dose of remifentanil. The bispectral index (BIS) was used to monitor the depth of anesthesia. Data regarding clinical findings, the effects of anesthesia, and the incidence of drug-related adverse effects were collected.

Results: In total, 102 patients completed the surgery successfully and safely. The dose of remifentanil was 0.02-0.07 μg/kg/min, 0.08-0.13 μg/kg/min, and 0.14-0.20 μg/kg/min in Groups A, B, and C, respectively. Only seven patients reported mild pain during the surgery. No significant differences were observed among the numeric rating scale scores of the three groups (p > 0.05). Intraoperative hemodynamics were stable. The incidence of respiratory depression was 8.3%, 20.0%, and 41.9% in Groups A, B, and C, respectively (p < 0.01). The incidence of gastrointestinal symptoms in Group C (51.6%) was higher than that in Groups A and B (p < 0.05).

Conclusion: Low-dose remifentanil (0.02-0.07 μg/kg/min) combined with dexmedetomidine achieved satisfactory anesthetic effects with fewer adverse drug reactions during PD catheter implantation, indicating its potential for use in patients undergoing PD catheter placement.

Keywords: Peritoneal dialysis; catheter implantation; conscious sedation anesthesia; dose; remifentanil.

Figure 1.

Intraoperative blood pressure changes in the mean arterial pressure among the three groups, and there was no difference, with mean arterial pressure above 65 mmHg (F = 1.565, p > 0.05).