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

摘要

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.