Improved sedation with dexmedetomidine-remifentanil compared with midazolam-remifentanil during catheter ablation of atrial fibrillation: A randomized, controlled trial

Jin Sun Cho, Jae Kwang Shim, Sungwon Na, Inhye Park, Young Lan Kwak

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Aims Anaesthesia is required for catheter ablation of atrial fibrillation (A-fib) to achieve patient comfort and immobilization to avoid map shifts. This study compared the analgesic and sedative efficacies of dexmedetomidine- remifentanil with those of midazolam-remifentanil for catheter ablation of A-fib. Methods and results Ninety patients were randomized to receive either intermittent midazolam boluses (1-2 mg) with 3.6-7.2 μg/kg/h of remifentanil (MR group) or dexmedetomidine 0.2-0.7 μg/kg/h after a loading dose of 1 μg/kg with 1.2-2.4 μg/kg/h of remifentanil (DR group). The sedation level assessed by the Ramsay sedation and bispectral index scores, haemodynamic variables, pain score (10-point numerical scale), and satisfaction levels of the patients and cardiologists (5-point numerical scale) were recorded. The Ramsay sedation score was significantly higher, and the bispectral index score was lower in the DR group (P< 0.001) compared with the MR group starting 10 min after drug administration. The incidence of desaturation (SpO2 < 90%) was significantly greater in the MR group compared with the DR group (15 vs. 1, P < 0.001). The pain score was significantly lower (1.72 ± 1.65 vs. 0.95 ± 1.10, P = 0.021), and the satisfaction levels of interventionists were significantly higher (2.50 ± 0.71 vs. 3.00 ± 0.63, P = 0.001) in the DR group compared with the MR group. Conclusion The combination of dexmedetomidine and remifentanil provided deeper sedation, less respiratory depression, better analgesia, and higher satisfaction for the interventionist during catheter ablation of A-fib compared with midazolam plus remifentanil, even at a lower dose of remifentanil.

Original languageEnglish
Pages (from-to)1000-1006
Number of pages7
JournalEuropace
Volume16
Issue number7
DOIs
Publication statusPublished - 2014 Jul

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Dexmedetomidine
Catheter Ablation
Midazolam
Atrial Fibrillation
Randomized Controlled Trials
Deep Sedation
Pain
remifentanil
Hypnotics and Sedatives
Patient Satisfaction
Immobilization
Respiratory Insufficiency
Analgesia
Analgesics
Anesthesia
Hemodynamics
Incidence
Pharmaceutical Preparations

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

@article{c4b3da6b4c514013a7df51e0808cb995,
title = "Improved sedation with dexmedetomidine-remifentanil compared with midazolam-remifentanil during catheter ablation of atrial fibrillation: A randomized, controlled trial",
abstract = "Aims Anaesthesia is required for catheter ablation of atrial fibrillation (A-fib) to achieve patient comfort and immobilization to avoid map shifts. This study compared the analgesic and sedative efficacies of dexmedetomidine- remifentanil with those of midazolam-remifentanil for catheter ablation of A-fib. Methods and results Ninety patients were randomized to receive either intermittent midazolam boluses (1-2 mg) with 3.6-7.2 μg/kg/h of remifentanil (MR group) or dexmedetomidine 0.2-0.7 μg/kg/h after a loading dose of 1 μg/kg with 1.2-2.4 μg/kg/h of remifentanil (DR group). The sedation level assessed by the Ramsay sedation and bispectral index scores, haemodynamic variables, pain score (10-point numerical scale), and satisfaction levels of the patients and cardiologists (5-point numerical scale) were recorded. The Ramsay sedation score was significantly higher, and the bispectral index score was lower in the DR group (P< 0.001) compared with the MR group starting 10 min after drug administration. The incidence of desaturation (SpO2 < 90{\%}) was significantly greater in the MR group compared with the DR group (15 vs. 1, P < 0.001). The pain score was significantly lower (1.72 ± 1.65 vs. 0.95 ± 1.10, P = 0.021), and the satisfaction levels of interventionists were significantly higher (2.50 ± 0.71 vs. 3.00 ± 0.63, P = 0.001) in the DR group compared with the MR group. Conclusion The combination of dexmedetomidine and remifentanil provided deeper sedation, less respiratory depression, better analgesia, and higher satisfaction for the interventionist during catheter ablation of A-fib compared with midazolam plus remifentanil, even at a lower dose of remifentanil.",
author = "Cho, {Jin Sun} and Shim, {Jae Kwang} and Sungwon Na and Inhye Park and Kwak, {Young Lan}",
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Improved sedation with dexmedetomidine-remifentanil compared with midazolam-remifentanil during catheter ablation of atrial fibrillation : A randomized, controlled trial. / Cho, Jin Sun; Shim, Jae Kwang; Na, Sungwon; Park, Inhye; Kwak, Young Lan.

In: Europace, Vol. 16, No. 7, 07.2014, p. 1000-1006.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Improved sedation with dexmedetomidine-remifentanil compared with midazolam-remifentanil during catheter ablation of atrial fibrillation

T2 - A randomized, controlled trial

AU - Cho, Jin Sun

AU - Shim, Jae Kwang

AU - Na, Sungwon

AU - Park, Inhye

AU - Kwak, Young Lan

PY - 2014/7

Y1 - 2014/7

N2 - Aims Anaesthesia is required for catheter ablation of atrial fibrillation (A-fib) to achieve patient comfort and immobilization to avoid map shifts. This study compared the analgesic and sedative efficacies of dexmedetomidine- remifentanil with those of midazolam-remifentanil for catheter ablation of A-fib. Methods and results Ninety patients were randomized to receive either intermittent midazolam boluses (1-2 mg) with 3.6-7.2 μg/kg/h of remifentanil (MR group) or dexmedetomidine 0.2-0.7 μg/kg/h after a loading dose of 1 μg/kg with 1.2-2.4 μg/kg/h of remifentanil (DR group). The sedation level assessed by the Ramsay sedation and bispectral index scores, haemodynamic variables, pain score (10-point numerical scale), and satisfaction levels of the patients and cardiologists (5-point numerical scale) were recorded. The Ramsay sedation score was significantly higher, and the bispectral index score was lower in the DR group (P< 0.001) compared with the MR group starting 10 min after drug administration. The incidence of desaturation (SpO2 < 90%) was significantly greater in the MR group compared with the DR group (15 vs. 1, P < 0.001). The pain score was significantly lower (1.72 ± 1.65 vs. 0.95 ± 1.10, P = 0.021), and the satisfaction levels of interventionists were significantly higher (2.50 ± 0.71 vs. 3.00 ± 0.63, P = 0.001) in the DR group compared with the MR group. Conclusion The combination of dexmedetomidine and remifentanil provided deeper sedation, less respiratory depression, better analgesia, and higher satisfaction for the interventionist during catheter ablation of A-fib compared with midazolam plus remifentanil, even at a lower dose of remifentanil.

AB - Aims Anaesthesia is required for catheter ablation of atrial fibrillation (A-fib) to achieve patient comfort and immobilization to avoid map shifts. This study compared the analgesic and sedative efficacies of dexmedetomidine- remifentanil with those of midazolam-remifentanil for catheter ablation of A-fib. Methods and results Ninety patients were randomized to receive either intermittent midazolam boluses (1-2 mg) with 3.6-7.2 μg/kg/h of remifentanil (MR group) or dexmedetomidine 0.2-0.7 μg/kg/h after a loading dose of 1 μg/kg with 1.2-2.4 μg/kg/h of remifentanil (DR group). The sedation level assessed by the Ramsay sedation and bispectral index scores, haemodynamic variables, pain score (10-point numerical scale), and satisfaction levels of the patients and cardiologists (5-point numerical scale) were recorded. The Ramsay sedation score was significantly higher, and the bispectral index score was lower in the DR group (P< 0.001) compared with the MR group starting 10 min after drug administration. The incidence of desaturation (SpO2 < 90%) was significantly greater in the MR group compared with the DR group (15 vs. 1, P < 0.001). The pain score was significantly lower (1.72 ± 1.65 vs. 0.95 ± 1.10, P = 0.021), and the satisfaction levels of interventionists were significantly higher (2.50 ± 0.71 vs. 3.00 ± 0.63, P = 0.001) in the DR group compared with the MR group. Conclusion The combination of dexmedetomidine and remifentanil provided deeper sedation, less respiratory depression, better analgesia, and higher satisfaction for the interventionist during catheter ablation of A-fib compared with midazolam plus remifentanil, even at a lower dose of remifentanil.

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