Randomized comparison of recovery time after use of remifentanil alone versus midazolam and meperidine for colonoscopy anesthesia

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Abstract

Background and Aim:

Although the combination of midazolam-meperidine has been widely used as a sedation regimen for colonoscopy, its residual effect which is longer than the duration of a colonoscopy procedure can delay patient recovery and discharge. Remifentanil, an ultra-short-acting opioid, has a very brief duration of action. We hypothesized that using remifentanil alone for colonoscopy would provide shorter recovery time compared with the midazolam-meperidine combination.

Methods:

Time to achieve Aldrete score = 10 was determined and compared in patients who were randomly allocated to receive remifentanil alone (group-R, n = 27) or a midazolam-meperidine combination (group-MM, n = 27) for colonoscopy. Intergroup differences in sedation, recall analgesia, cardio-respiratory profiles, and satisfaction of patient and endoscopist were also determined during and after colonoscopy.

Results:

Group-R showed a significantly shorter recovery time than group-MM (median [25–75%], 0 [0–10] vs 30 [15–30] min, P < 0.001). Group-R showed significantly higher bispectral-index values during colonoscopy (92 [85–96] vs 84 [80–87], P = 0.001); a higher incidence of recall of explanations given during and after colonoscopy (100 vs 48% and 96 vs 52%, both P < 0.001); and a lower distress score (visual analog scale 30/100 vs 37/100 mm, P = 0.002), than did group-MM. Neither extent of pain, incidence of hemodynamic instability nor incidence of respiratory depression differed between the groups.

Conclusions:

Remifentanil for colonoscopy afforded faster recovery compared to midazolam-meperidine combination. It also provided greater patient–endoscopist communication and satisfaction with comparable patient analgesia and cardiorespiratory profile during colonoscopy.

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