Comparison of alfentanil and remifentanil for the use of patient controlled sedation under local anesthesia during ear , nose and throat surgery

Background: This study was conducted to compare the effects of alfentanil and remifentanil on patient controlled sedation (PCS). Methods: 60 patients scheduled for ear, nose and throat surgery under local anesthesia were randomly allocated to Group P (n = 20, propofol 10 mg/ml), Group A (n = 20, propofol 10 mg/ml with alfentanil 500 μg/ml) and Group R (n = 20, propofol 10 mg/ml with remifentanil 10 μg/ml). Without a basal rate, bolus was set to 2 ml with one minute of lockout time. Results: A total of 57 patients were included in this study. Group A was found to have a lower blood pressure and pulse rate than group R. Group R showed a lower PCS dose upto an OAA/S (Observer’s Assessment of Alertness/Sedation Scale) value of 4 and a higher OAA/S prior to surgery than group P. Group P was found to have a higher blood pressure and respiration rate than Group A. During PCS, patient anxiety was significantly decreased in all groups. In addition, there was no differences among groups in the level of pain during the perioperative period, delivery/attempt ratio, satisfaction of the patient and surgeon, and number of patients required to undergo the same PCS technique again. The frequency of side effects of PCS, which included pain on injection, transient hypertension, hypotension, desaturation and oversedation, were similar among groups. Conclusions: Evaluation of patients who underwent ear, nose and throat surgery under local anesthesia using PCS with propofol alone or alfentanil or remifentanil revealed no differences in safety, effectiveness, complications or satisfaction of the patients and surgeons. (Korean J Anesthesiol 2009; 56: 507~12)