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British Journal of Anaesthesia, 2002, Vol. 89, No. 4 637-640
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia

Short Communications

Remifentanil or propofol for sedation during carotid endarterectomy under cervical plexus block

H. Krenn*,1, E. Deusch2, H. Jellinek1, W. Oczenski1 and R. D. Fitzgerald1,3

1 Department of Anaesthesia and Intensive Care, City of Vienna Hospital Lainz, A-1130 Vienna, Austria. 2 Department of Anaesthesiology and Intensive Care B, General Hospital, Vienna, Austria. 3 Ludwig Boltzmann Institute for Economics of Medicine in Anaesthesia and Intensive Care, Vienna, Austria*Corresponding author

Background. During carotid endarterectomy under regional anaesthesia, patients often require medication to control haemodynamic instability and to provide sedation and analgesia. Propofol and remifentanil are used for this purpose. However, the benefits, side-effects, and optimal dose of these drugs in such patients are unclear.

Methods. Sixty patients were included in a prospective, randomized, single blinded study. All patients received a deep cervical plexus block with 30 ml ropivacaine 0.75% and were randomized to receive either remifentanil 3 µg kg–1 h–1 or propofol 1 mg kg–1 h–1. The infusions were started after performing the regional block and were stopped at the end of surgery. Arterial pressure, ECG, ventilatory rate, and PaCO2 were measured continuously and recorded at predetermined times. Twenty-four hours after surgery, patient comfort, and satisfaction were also evaluated.

Results. In three patients, the infusion of remifentanil had to be stopped because of severe respiratory depression or bradycardia. No significant differences were found between the two groups in haemodynamic variables or sedative effects, but there was a significantly greater decrease in ventilatory frequency and increase in PaCO2 in the remifentanil group. The patient’s subjective impressions and pain control were excellent in both groups.

Conclusion. As a result of the higher incidence of adverse respiratory effects with remifentanil and similar sedative effects, propofol is preferable for sedation during cervical plexus block in elderly patients with comorbid disease at the dosage used.

Br J Anaesth 2002; 89: 637–40


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