Comparison of Propofol, Propofol-Remifentanil, and Propofol-Fentanyl Administrations with Each Other Used for the Sedation of Patients to Undergo ERCP

Abstract

Introduction. Using single anesthetic agent in endoscopic retrograde cholangiopancreatography (ERCP) may lead to inadequate analgesia and sedation. To achieve the adequate analgesia and sedation the single anesthetic agent doses must be increased which causes undesirable side effects. For avoiding high doses of single anesthetic agent nowadays combination with sedative agents is mostly a choice for analgesia and sedation for ERCP. Aim. The aim of this study is to investigate the effects of propofol alone, propofol + remifentanil, and propofol + fentanyl combinations on the total dose of propofol to be administered during ERCP and on the pain scores after the process. Materials and Method. This randomized study was performed with 90 patients (ASA I-II-III) ranging between 18 and 70 years of age who underwent sedation/analgesia for elective ERCP. The patients were administered only propofol (1.5 mg/kg) in Group Ι, remifentanil (0.05 μg/kg) + propofol (1.5 mg/kg) combination in Group II, and fentanyl (1 μg/kg) + propofol (1.5 mg/kg) combination in Group III. All the patients' sedation levels were assessed with the Ramsey Sedation Scale (RSS). Their recovery was assessed with the Aldrete and Numerical Rating Scale Score (NRS) at 10 min intervals. Results. The total doses of propofol administered to the patients in the three groups in this study were as follows: 375 mg in Group I, 150 mg in Group II, and 245 mg in Group III. Conclusion. It was observed that, in the patients undergoing ERCP, administration of propofol in combination with an opioid provided effective and reliable sedation, reduced the total dose of propofol, increased the practitioner satisfaction, decreased the pain level, and provided hemodynamic stability compared to the administration of propofol alone.

Comparison of The Effects of Remifentanil and Fentanyl Combined with Desflurane on Intraoperative Hemodynamic Parameters and Postoperative Recovery Period in Anesthesia for Day Case Surgery

“…These findings were consistent with the literature. Similar findings are declared between the two groups in the many studies (Mulas et al,1998;Doyle et al,2001;Haytural, 2015, Monsef et al, 2019.…”

“…In their study with 16 patients from the remifentanil and fentanyl groups, some authors reported that 7 patients in the remifentanil group and Comparison of the effects of Remifentanil and Fentanyl for day case surgery 4 patients in the fentanyl group had analgesic requirements in the early post-operative period (Doyle et al,2001). But the others found no difference VAS scores between fentanyl and remifentanil group in their studies (Haytural, 2015). On the other hand; some other authors found higher VAS scores in the fentanyl group (Monsef et al, 2019).We didn't administer additional analgesics in our study, but when the VAS scores were evaluated, it was concluded that pain control was better achieved in patients treated with fentanyl in the early period.…”

The use of remifentanil in critically ill patients undergoing percutaneous dilatational tracheostomy: A prospective randomized‐controlled trial

“…The recovery time is a little longer in P group than in PR group accordingly due to a larger use of propofol. In Haytural et al's research in which the patients undergo endoscopic retrograde cholangiopancreatography (ERCP), patients in the propofol group need more propofol than the other groups using remifentanil and fentanyl along with propofol, which is the same like our study . Remifentanil decreases the doses of propofol and makes the recovery time shorter.…”

“…Haytural et al's research in which the patients undergo endoscopic retrograde cholangiopancreatography (ERCP), patients in the propofolgroup need more propofol than the other groups using remifentanil and fentanyl along with propofol, which is the same like our study 21. Remifentanil decreases the doses of propofol and makes the recovery time shorter.MR happens in 4 (8.2%) patients in PR group compared with 0 in P group.…”

Remifentanil infusion versus propofol and remifentanil patient controlled sedation/analgesia for moderate sedation during interventional radiological procedures: A prospective randomized trial

“…Moderate sedation provides a low risk of serious adverse events with all currently available agents (2). Medication used in moderate sedation should have minimum side effects, it should depress the patient's consciousness level in a controlled manner, and it should have inactive metabolites, and should not necessitate resedation (3,4).…”