Evaluation Of The Effect And Security On Remifentanil-Propofol In Gastroscopy

Objective: To evaluate the sedative and analgesic efficiency and security and screen out the proper dosage of remifentanil-propofol by intravenous injection in gastroscopy. Methods:1. 75 patients were randomly divided into 3groups (25 patients per group): received intravenous remifentanil 0.25μg.kg-1(groupⅠ), 0.5μg.kg-1(groupⅡ), 0.75μg.kg-1(group Ⅲ) respectively, intravenous propofol were followed. The variation of blood pressure(BP), heart rate(HR), peripheral oxygen saturation(SPO2),dosage of propofol and the reaction of patients were observed. 2. 331 patients were randomly divided into three groups: remifentanil-propofol (Rem group, groupⅠ), fentanyl-propofol (Fen group, group Ⅱ)and ordinary gastroscopy group(group Ⅲ). The variation of BP, HR, SPO2, the dosage of propofol and the reaction of patients were observed when difference program given. The serum norepinephrine(NE) concentration were also measured before and after the gastroscopy. Questionnaires for patients were performed after gastroscopy. Result: 1. All procedures were completed easily without significant complication. Much less reaction of patients were observed in groupⅡand Ⅲ than in groupⅠ(P<0.05), the time of gastroscopy in groupⅡand Ⅲ was shorter than in groupⅠ(P<0.01). SPO2 during the procedure in groupⅢ were lower than in groupⅠand Ⅱ(P<0.05). BP decreased during the procedure in groupⅠ,ⅡandⅢ(P<0.01), howevere, it recoverd to baseline immediately after gastroscopy. 2. All operation were completed easily without significant complication. Much less reaction of patients were observed in groupⅠand Ⅱthan in groupⅢ (P<0.01).Patients in groupⅠandⅡfelt much less discomfortable than in groupⅢ, the time of gastroscopy in groupⅠandⅡwere shorter than in groupⅢ(P<0.01). The awaken time in groupⅠwas shorter than in groupⅡ(P<0.01). BP, SPO2 decreased during the procedure in groupⅠandⅡ, however, they recoverd to baseline immediately after gastroscopy. HR decreased significantly during the procedure in groupⅡ(P<0.01),but no significant descent were observed in groupⅠ. All serum NE concentrations after gastroscopy were increased (P<0.01),and significantly higher in groupⅢ than in groupⅠandⅡ(P<0.01), but no significant difference was observed between groupⅠandⅡ(P>0.05). In patients with hypertension and older patients, the dosage of propofol was lower than patients without hypertension and younger patients, and awaken time were also shorter than patients without hypertension and younger patients (P<0.05), while, their circulatory dynamics were stable . Conclusion: When remifentanil with propofol for gastroscopy, the proper dosage of remifentanil was 0.5μg.kg-1. Using remifentanil-propofol or fentanyl-propofol via intravenous injection can reduce stress in gastroscopy and make gastroscopy more comfortable, more effective and safer, especially remifentanil-propofol is more suitable for gastroscopy with sedation.