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ANESTHETIC PHARMACOLOGY

A Comparison of Patient-Controlled Sedation Using Either Remifentanil or Remifentanil-Propofol for Shock Wave Lithotripsy

Hwan S. Joo, MD FRCPC^*, William J. Perks, Phm, Mark T. Kataoka, MD FRCPC^*, Lee Errett, MD FRCSC, Kenneth Pace, MD FRCSC, and R. John Honey, MD FRCSC

Departments of *Anaesthesia and Pharmacy, Divisions of Cardiac Surgery and Urology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada

Address correspondence to Hwan Joo, MD, Department of Anaesthesia, St. Michael’s Hospital, University of Toronto, 30 Bond St., Toronto, Ontario, Canada M5B 1W8. Address e-mail to hwanjoom{at}yahoo.com

Patient-controlled sedation (PCS) has been used for extracorporeal shock wave lithotripsy (SWL) because it allows for rapid individualized titration of anesthetics. Because of its sedating effects, the addition of propofol to remifentanil may improve patient tolerance of SWL with PCS. One hundred twenty patients were randomly assigned to receive remifentanil 10 µg or remifentanil 10 µg plus propofol 5 mg for PCS with zero-lockout interval. Nine patients in the Remifentanil group and three patients in the Remifentanil-Propofol group required additional sedatives to complete their SWL (P = 0.128). Compared with the Remifentanil group, the Remifentanil-Propofol group required less remifentanil, had a decreased incidence of postoperative nausea and vomiting, and had a better overall satisfaction level. However, they had an increased incidence of transient apnea and oxygen desaturation. The incidence of apnea was 15% in the Remifentanil group and 52% in the Remifentanil-Propofol group (P < 0.001). All patients were able to move themselves to the stretcher at the end of SWL, and median time to home discharge was <70 min in both groups. Both remifentanil and remifentanil-propofol were useful for PCS during SWL.

IMPLICATIONS: The addition of propofol to remifentanil improves patient satisfaction and decreases postoperative nausea and vomiting. However, it causes more respiratory depression than remifentanil alone. When remifentanil-propofol is used with patient-controlled sedation, appropriate monitoring and a minimum 1–2 min lockout interval is required.

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