Improved sedation with dexmedetomidine-remifentanil compared with midazolam-remifentanil during catheter ablation of atrial fibrillation: a randomized, controlled trial

Europace. 2014 Jul;16(7):1000-6. doi: 10.1093/europace/eut365. Epub 2013 Dec 30.

Abstract

Aims: Anaesthesia is required for catheter ablation of atrial fibrillation (A-fib) to achieve patient comfort and immobilization to avoid map shifts. This study compared the analgesic and sedative efficacies of dexmedetomidine-remifentanil with those of midazolam-remifentanil for catheter ablation of A-fib.

Methods and results: Ninety patients were randomized to receive either intermittent midazolam boluses (1-2 mg) with 3.6-7.2 µg/kg/h of remifentanil (MR group) or dexmedetomidine 0.2-0.7 µg/kg/h after a loading dose of 1 µg/kg with 1.2-2.4 µg/kg/h of remifentanil (DR group). The sedation level assessed by the Ramsay sedation and bispectral index scores, haemodynamic variables, pain score (10-point numerical scale), and satisfaction levels of the patients and cardiologists (5-point numerical scale) were recorded. The Ramsay sedation score was significantly higher, and the bispectral index score was lower in the DR group (P< 0.001) compared with the MR group starting 10 min after drug administration. The incidence of desaturation (SpO2 < 90%) was significantly greater in the MR group compared with the DR group (15 vs. 1, P < 0.001). The pain score was significantly lower (1.72 ± 1.65 vs. 0.95 ± 1.10, P = 0.021), and the satisfaction levels of interventionists were significantly higher (2.50 ± 0.71 vs. 3.00 ± 0.63, P = 0.001) in the DR group compared with the MR group.

Conclusion: The combination of dexmedetomidine and remifentanil provided deeper sedation, less respiratory depression, better analgesia, and higher satisfaction for the interventionist during catheter ablation of A-fib compared with midazolam plus remifentanil, even at a lower dose of remifentanil.

Keywords: Atrial fibrillation; Catheter ablation; Conscious sedation; Dexmedetomidine; Midazolam; Remifentanil.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / physiopathology
  • Atrial Fibrillation / surgery*
  • Attitude of Health Personnel
  • Catheter Ablation* / adverse effects
  • Conscious Sedation / adverse effects
  • Conscious Sedation / methods*
  • Consciousness Monitors
  • Dexmedetomidine / administration & dosage*
  • Dexmedetomidine / adverse effects
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Female
  • Hemodynamics / drug effects
  • Humans
  • Hypnotics and Sedatives / administration & dosage*
  • Hypnotics and Sedatives / adverse effects
  • Intraoperative Neurophysiological Monitoring / instrumentation
  • Male
  • Midazolam / administration & dosage*
  • Midazolam / adverse effects
  • Middle Aged
  • Pain Perception / drug effects
  • Pain Threshold / drug effects
  • Patient Satisfaction
  • Piperidines / administration & dosage*
  • Piperidines / adverse effects
  • Prospective Studies
  • Remifentanil
  • Republic of Korea
  • Time Factors
  • Treatment Outcome

Substances

  • Hypnotics and Sedatives
  • Piperidines
  • Dexmedetomidine
  • Remifentanil
  • Midazolam