Dexmedetomidine versus remifentanil for sedation under monitored anesthetic care in complex endovascular aortic aneurysm repair: a single center experience with mid-term follow-up.

Abstract

BACKGROUND:

Sedation protocols in patients undergoing complex endovascular aortic aneurysm repair are not fully investigated. The aim of this study was to compare a dexmedetomidine (DEX) based sedation protocol with a remifentanil-based sedation protocol.

METHODS:

Seventy-nine consecutive patients undergoing complex endovascular aortic repair were enrolled and retrospectively analyzed. Forty-two received 0.03 mg/kg midazolam intravenous bolus with remifentanil (0.075-0.1 μg/kg/min for 10 minutes followed by continuous infusion 0.050-0.25 μg/kg/min) and 37 DEX (1 μg/kg over 10 minutes and continuous infusion 0.50-0.75 μg/kg/hour) to achieve an Observer Assessment of Alertness/Sedation Scale (OAAS) ≤4, a Richmond Agitation/Sedation Scale (RASS) ≤-2 and a Visual Analogic Scale (VAS) <4. The primary endpoint was patients' satisfaction. Secondary endpoints included assessment of sedation and pain, the incidence of perioperative hemodynamic or gas exchange imbalance, and 36 month-mortality.

RESULTS:

Remifentanil group showed a higher satisfaction rate than DEX (P<0.001). Patients on DEX were more sedated than remifentanil according to OAAS (3 [2-3] vs. 4 [3-4]; P=0.001) and RASS (-2[-3/-2] vs. -2[-2/-2]; P=0.001) with no difference in VAS (2 [1-3] vs. 2 [1-3]; P=0.41). DEX provides reliable sedation with lower patient's satisfaction. A higher number of patients were discharged from the recovery room on vasopressors in the DEX group compare with the remifentanil group (5 vs. 0; P=0.045, respectively). The two groups showed a non-significant difference in the survival rate at 36-month (DEX 67% vs. remifentanil 73%; (P=0.90).

CONCLUSIONS:

In this setting remifentanil provides reliable sedation with higher patient's satisfaction and less hemodynamic effect than DEX.

• Authors: Fabrizio Monaco, Gaia Barucco, Caterina C Lerose, Monica DE Luca, Margherita Licheri, Marta Mucchetti, Rosa Labanca, Federica Morselli, Cristina Mattioli, Federica Russetti, Alberto Zangrillo
• Journal: Minerva anestesiologica (Minerva Anestesiol) Vol. 89 Issue 4 Pg. 256-264 (04 2023) ISSN: 1827-1596 [Electronic] Italy
• PMID: 36651372 (Publication Type: Journal Article)

Chemical References

• Remifentanil
• Dexmedetomidine
• Hypnotics and Sedatives
• Anesthetics

Topics

• Humans
• Remifentanil
• Dexmedetomidine
• Hypnotics and Sedatives
• Retrospective Studies
• Follow-Up Studies
• Anesthetics
• Aortic Aneurysm