Search

Colonoscopy is one of the most common procedures. Sedation and analgesia decrease anxiety and discomfort and minimize risks. Therefore, patients prefer to be sedated when undergoing examination, although the best combination of drugs has not been determined. The combination of opioids and benzodiazepines is used to relieve the patient's pain and discomfort. More recently, propofol has assumed a prominent position. This randomized prospective study is unique in medical literature that specifically compared the use of propofol and fentanyl with or without midazolam for colonoscopy sedation performed by anesthesiologists. The aim of this study was to evaluate the side effects of sedation, discharge conditions, quality of sedation, and propofol consumption during colonoscopy, with or without midazolam as preanesthetic. The study involved 140 patients who underwent colonoscopy at the University Hospital of the Federal University of Juiz de Fora. Patients were divided into two groups: Group I received intravenous midazolam as preanesthetic 5min before sedation, followed by fentanyl and propofol; Group II received intravenous anesthesia with fentanyl and propofol. Patients in Group II had a higher incidence of reaction (motor or verbal) to the colonoscope introduction, bradycardia, hypotension, and increased propofol consumption. Patient satisfaction was higher in Group I. According to the methodology used, the combination of midazolam, fentanyl, and propofol for colonoscopy sedation reduces propofol consumption and provides greater patient satisfaction., (Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.)

Background and Objective: Thoracic epidural analgesia and patient-controlled analgesia (PCA) with intravenous fentanyl have both been shown to be effective in pediatric patients treated surgically for pectus excavatum using the Nuss procedure. We compare the efficacy and safety of these techniques., Methods: Retrospective study of pediatric cases in which the Nuss procedure was used to treat pectus excavatum between October 1997 and February 2009. Weight, age, sex, and Haller index were analyzed. Pain was assessed every 8 hours on a visual analog scale of 0 to 10 or on a scale based on observation of distress (LLANTO scale). Daily use of analgesics was also recorded. The incidence of catheter-related complications or adverse events of treatment such as nausea, vomiting, and respiratory depression were also noted., Results: We identified 31 patients in 2 groups: the epidural group (n=22) and the PCA group (n=9). Demographic characteristics, the incidences of complications or adverse events, and mean (SD) pain scores (epidural group, 1.8 [3.8]; PCA group, 2.1 [3.4]; P = .775) were statistically similar in the 2 groups. However, analgesic requirements and the duration of analgesic use in days differed significantly, at 2.9 (1.1) days in the epidural group and 5.9 (1.4) days in the PCA group (P =.001)., Conclusions: The efficacy and safety of thoracic epidural analgesia is similar to that of PCA with intravenous fentanyl, although the use of epidural analgesia is associated with a markedly shorter duration of requirement for postoperative analgesia.

Aims: To study the possible pharmacodynamic differences in children under anesthesia based on remifentanil., Methods: This multicenter observational study enrolled 275 patients scheduled for minor pediatric surgery (herniorrhaphy, prepuceplasty, and plastic surgery). The children were grouped by age: 1-3 years, 4-7 years, 8-12 years. Premedication was with midazolam, induction with sevoflurane or propofol, and maintenance with sevoflurane 0.5%-0.8%, N2O/O2 30%/70%, and remifentanil 0.25 microg/kg/min. Postoperative analgesia (metamizol, morphine or regional block) was administered at least 30 minutes before the end of surgery., Results: No differences were found between age groups with regard to remifentanil requirements, end tidal concentrations of sevoflurane, or mean times until spontaneous ventilation or extubation. Nor were there differences in the percentages of complications (5.4%), of which 4 were cases of intense postoperative muscular rigidity, or in the incidence of nausea-vomiting (3.4%). The quality of recovery from anesthesia (Aldrete test) was better in the 8-12-year-old group (P < 0.05), however, while agitation (Postoperative Agitation Score) and pain (visual analog scale or observational scales) were greater in the group of 1-3-year-olds (P < 0.05). The evaluation of the technique by participating caregivers was excellent for 20%, very good for 41%, good for 29%, adequate for 8% and poor for 2% of the cases.