Safety and Efficacy of Remifentanil for Single Agent Procedural Sedation: A Systematic Review

Background: More procedures are performed in sedation alone or as an adjunct to local anesthesia. Hence, the diversity of the procedures and the patients are increasing along with the need for suitable sedative alternatives. Objective: The purpose of this study was to assess the safety and efficacy of remifentanil monotherapy for procedure sedation. Design: Systematic review of randomised controlled trials without meta-analyses. Data-sources: Electronic search of Pubmed, EMBASE, The Cochrane Library, and Web of Knowledge. No date or language limitations were applied. Eligibility criteria: Only full-text articles of remifentanil monotherapy for procedural analgesia/sedation were eligible. Remifentanil as an adjunct to local anesthesia was also considered. Results: Twenty one randomised controlled trials (718 vs. 719 patients) were included. Sedation related mortality was zero. The rate of hypoxia was lower (26 vs 56, P<0.005) in the remifentanil group, fewer needed assisted ventilation (2 vs 15, p<0.005), there was a lower incidence of blood pressure deviation (0.2% vs 7.3%, P<0.005), less procedures were incomplete or needed rescue therapy (4 vs 12, P=0.045) and patients experienced more nausea and\or vomiting (16.5% vs 10.2%, P=0.004). Conclusion: Remifentanil sedation can be performed with few adverse events as long as the patient is reminded to breathe firmly. Patients experience more nausea and vomiting after remifentanil sedation compared with propofol sedation, but expresses no difference in satisfaction.