Comparison of remifentanil with dexmedetomidine for monitored anaesthesia care in elderly patients during vertebroplasty and kyphoplasty

Jung Min Lee, Soo Kyung Lee, Sang Jun Lee, Woon Suk Hwang, Sung Wook Jang, Eun Young Park, Jung Min Lee, Soo Kyung Lee, Sang Jun Lee, Woon Suk Hwang, Sung Wook Jang, Eun Young Park

Abstract

Objectives: This clinical trial is registered at ClinicalTrials.gov. (NCT02476981)This randomized, prospective double-blind study compared remifentanil with dexmedetomidine for monitored anaesthesia care during minimally invasive corrections of vertebral compression fractures (vertebroplasty or kyphoplasty).

Methods: Patients > 65 years of age with American Society of Anesthesiologists (ASA) classification I-III, scheduled for vertebroplasty or kyphoplasty under monitored anaesthesia care, received remifentanil (i.v. infusion 1-5 µg/kg/h) or dexmedetomidine (loading dose 0.3-0.4 µg/kg followed by i.v. infusion 0.2-1 µg/kg/h) to maintain observer's assessment of alertness/sedation (OAA/S) scale <4 during the procedure.

Results: There were no statistically significant differences in demographic data between the remifentanil (n = 37) and dexmedetomidine groups (n = 38). Patients on dexmedetomidine experienced lower mean arterial pressure (MAP) and heart rate (HR), and higher SpO2 values, than patients on remifentanil. Compared with dexmedetomidine, remifentanil produced more respiratory depression, oxygen desaturation, and reduced the need for additional intraoperative opioids. There were no significant between-group differences in terms of recovery time, investigators' satisfaction scores, or patients' overall pain experiences.

Conclusions: During monitored anaesthesia care, dexmedetomidine provides less respiratory depression, lower MAP and HR, but also less analgesic effect than remifentanil in elderly patients undergoing vertebroplasty or kyphoplasty.

Keywords: Remifentanil; dexmedetomidine; kyphoplasty; monitored anaesthesia care; elderly; vertebroplasy.

© The Author(s) 2016.

Figures

Figure 1.
Figure 1.
Changes in (a) mean arterial pressure (MAP), (b) heart rate (HR), (c) oxygen desaturation (SpO2) and (d) respiratory rate (RR) in patients >65 years of age receiving remifentanil and dexmedetomidine during vertebroplasty or kyphoplasty (T0, baseline; T1, lidocaine infiltration; T2, trocar insertion; T3, cement insertion; T4, skin closure). Variables of MAP, HR and SpO2 showed significant difference over time between both groups, using repeated-measures analysis of variance (ANOVA). Intergroup differences at the same time point were analysed using a two-sample t-test (*P < 0.05)

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