Eur J Anaesthesiol 2015 Sep 32(9): 602-8

Authors: Fassoulaki A MD et al

Background:

Propofol alone or combined with opioids is considered the drug of choice for sedation during endoscopic retrograde cholangiopancreatography (ERCP).

OBJECTIVE:

To investigate the effect of pre or intraprocedural opioids on propofol requirement during deep sedation for ERCP, and on recovery, pain and cognitive function postoperatively.

DESIGN:

Three-arm, double-blinded randomised controlled trial.

SETTING:

Aretaieio University Hospital, February 2011 to July 2013.

PATIENTS:

One hundred and eighty adults aged between 45 and 75 years.

INTERVENTIONS:

Deep sedation with propofol (target bispectral index 40 to 70) was performed. In the remifentanil group (R), patients received intranasal placebo before ERCP, and remifentanil 0.1 ml kg(-1) h(-1) (concentration 10 μg ml(-1)) during ERCP. In the fentanyl group (F), patients received intranasal fentanyl 200 μg before ERCP and placebo during ERCP. In the placebo group (P), patients received intranasal placebo before ERCP and placebo during ERCP.

MAIN OUTCOME MEASURES:

The primary outcome was total propofol requirement. Secondary outcomes were recovery [assessed using the Ramsay Sedation Scale score and Observer’s Assessment of Alertness/Sedation Score (OAAS)] at 30 min; postoperative pain [assessed using a visual analogue pain scale (VAS; 0 to 100 mm)]; and cognitive function [assessed using a MiniMental state test (max. 25 points) 30 min before and 30 min after ERCP].

RESULTS:

Fifty-seven patients were included in group R, 59 in group F and 57 in group P. Propofol requirements for deep sedation were similar in all groups (13 mg kg(-1); P = 0.97). Ramsay Sedation Scale scores and OAAS scores were similar in all groups (P = 0.18 and P = 0.55, respectively). Postoperative median pain VAS differed among the groups (P = 0.007): 10 in group R, 0 in group F, five in group P. Cognitive function was high pre and postprocedure (median MiniMental state test 23 to 24) and not different among the groups.

CONCLUSION:

The addition of pre or intraprocedural opioids had no effect on propofol requirement for deep sedation, but patients who received fentanyl had less minor pain.