This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Web of Science (13) Citing Articles via Google Scholar Google Scholar Articles by Greilich, P. E. Articles by Harford, W. V. Search for Related Content PubMed PubMed Citation Articles by Greilich, P. E. Articles by Harford, W. V. Related Collections Ambulatory Pharmacology

---

AMBULATORY ANESTHESIA

Remifentanil Versus Meperidine For Monitored Anesthesia Care: A Comparison Study in Older Patients Undergoing Ambulatory Colonoscopy

Philip E. Greilich, MD^*,, Cesar D. Virella, MD^*,, James M. Rich, MA, CRNA^*,, Mangala Kurada, MD^*, Kevin Roberts, PharmD, James F. Warren, MD^*, and William V. Harford, MD^*,

*University of Texas Southwestern Medical Center–Dallas, and Veterans Affairs North Texas Health Care Dallas, Texas

Address correspondence and reprint requests to Philip E. Greilich, MD, Anesthesiology & Pain Management Service (112A), Veterans Affairs North Texas Health Care System, 4500 South Lancaster Road/Dallas, TX 75216. Address e-mail to philip.greilich @email.swmed.edu.

Colonoscopy is one of the most frequently performed outpatient procedures in the United States. This study was designed to test the hypothesis that a remifentanil infusion would be superior to boluses of meperidine in older patients undergoing ambulatory colonoscopy. One hundred ASA physical status I-IV patients undergoing colonoscopy were randomized in this double-blinded study to receive either remifentanil infusions (n = 49) or titrated boluses of meperidine (n = 51). Patient tolerance was assessed using physiologic variables and side effects associated with opioid analgesia. Verbal pain/anxiety and patient/operator satisfaction were also assessed. As a group, the physiologic characteristics demonstrated no significant differences in the response to the colonoscopy procedure. Although the patient and operator satisfaction surveys were similar between groups, the incidences of tachycardia, hypotension, and nausea were less and the adjusted verbal pain and anxiety scores were more in the Remifentanil group compared with the Meperidine group. This study demonstrates that remifentanil and meperidine were equally well tolerated in older patients undergoing ambulatory colonoscopy when administered by an anesthesia provider. The differences in the pharmakinetics of remifentanil and meperidine most likely account for the differences noted between the two treatment groups.

Implications: Remifentanil infusions and meperidine boluses are equally well tolerated in older patients undergoing ambulatory colonoscopy when administered by an anesthesia provider.