Correlación entre propofol y remifentanilo mediante infusión controlada por objetivo en sitio efecto para sedación en procedimientos colonoscópicos
Fecha
2016
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
La colonoscopia es un procedimiento ambulatorio breve que sin embargo puede
causar molestias durante su ejecución. Por este motivo requiere que el paciente
sea sedado, procedimiento que se ha realizado por años mediante la
administración de medicamentos en bolo según la valoración subjetiva de la
respuesta a la infusión por parte del anestesiólogo. Actualmente la Infusión
Controlada por Objetivo (ICO) permite que la respuesta sea valorada de manera
objetiva mediante análisis biespectral. (ABE). Con el objetivo de Establecer el
fármaco más efectivo y seguro para ser administrado mediante ICO, para la
sedación de pacientes indicados con procedimientos colonoscópicos, se realizó un
ensayo clínico controlado aleatorio sin cegamiento en etapa IV en el que se
incluyeron 100 casos consecutivos de personas con indicación electiva de éste
procedimiento endoscópico en el Hospital-Clínica Kennedy de la ciudad de
Guayaquil, las mismas que fueron asignadas de manera equilibrada y aleatoria
para recibir propofol (n= 50) o Remifentanil (n= 50). Los resultados no mostraron
efectos adversos o complicaciones atribuibles a los medicamentos. Los valores de
los parámetros hemodinámicos no reportaron diferencias estadísticamente
significativas (P > 0.05) excepto al momento de la finalización del procedimiento (P
< 0.05) sin que se registraran sin embargo hipoxemia o hipotensión. El IBE tampoco
mostró diferencias (P > 0.05) La valoración de los niveles de sedación con Ramsay
mostró diferencias estadísticamente significativas entre los grupos (P < 0.05), pero
en general los pacientes estuvieron alertas siempre. Se concluye que los efectos y
seguridad de ambos esquemas administrados por ICO son equivalentes.
Colonoscopy is a brief outpatient procedure that nevertheless can cause discomfort during execution. For this reason it requires that the patient is sedated, a procedure that has been done for years by administering drugs bolus according to the subjective assessment of the response to the infusion by the anesthesiologist. Currently the target controlled infusion (ICO) allows the response to be objectively assessed by bispectral analysis. (ABE). Aiming to establish the drug most effective and safe to be administered by ICO, for sedation of patients indicated colonoscopic procedures, a randomized controlled unblinded stage IV clinical trial in which 100 consecutive cases of persons were included performed elective indication of this endoscopic procedure in Kennedy Hospital from Guayaquil city, the same that were allocated in a balanced and randomized to receive propofol (n = 50 or remifentanil (n = 50). the results showed no adverse effects or complications attributable to medicines. the parameter values hemodynamic reported no statistically significant differences (P> 0.05) except at the time of completion of the procedure (P <0.05) without being recorded however hypoxemia or hypotension. the IBE also showed no difference (P> 0.05) valuation levels Ramsay sedation showed statistically significant differences between groups (P <0.05), but in general the patients were alert at all times. It is concluded that the effects and safety of both administered by ICO schemes are equivalent.
Colonoscopy is a brief outpatient procedure that nevertheless can cause discomfort during execution. For this reason it requires that the patient is sedated, a procedure that has been done for years by administering drugs bolus according to the subjective assessment of the response to the infusion by the anesthesiologist. Currently the target controlled infusion (ICO) allows the response to be objectively assessed by bispectral analysis. (ABE). Aiming to establish the drug most effective and safe to be administered by ICO, for sedation of patients indicated colonoscopic procedures, a randomized controlled unblinded stage IV clinical trial in which 100 consecutive cases of persons were included performed elective indication of this endoscopic procedure in Kennedy Hospital from Guayaquil city, the same that were allocated in a balanced and randomized to receive propofol (n = 50 or remifentanil (n = 50). the results showed no adverse effects or complications attributable to medicines. the parameter values hemodynamic reported no statistically significant differences (P> 0.05) except at the time of completion of the procedure (P <0.05) without being recorded however hypoxemia or hypotension. the IBE also showed no difference (P> 0.05) valuation levels Ramsay sedation showed statistically significant differences between groups (P <0.05), but in general the patients were alert at all times. It is concluded that the effects and safety of both administered by ICO schemes are equivalent.
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Colonoscopía, Anestesia, Propofol, Remifentanilo, Hospital Clínica Kennedy, Cantón Guayaquil, Ecuador