Zusammenfassung
Ziel: Die Entwicklung eines einfach zu handhabenden Protokolls für Radiologen zur Analgosedierung bei schmerzhaften interventionellen Eingriffen. Methoden: Prospektiv wurden 72 konsekutive Patienten zusammengefasst, bei denen schmerzhafte interventionelle Eingriffe geplant waren. Die Analgosedierung erfolgte mit einer Kombinationsmedikation aus kurzwirksamem Piperidinderivat (Alfentanil [Rapifen®]; 7,5 - 15 µg/kg KG) und Benzodiazepin (Midazolam [Dormicum®]; 20 µg/kg KG). Nach präinterventioneller Oxygenierung wurde ein kontinuierliches Monitoring durchgeführt. Das subjektive Schmerzempfinden der Patienten wurde mit einem visuellen Analogscore (0 - 10) erfasst. Die Kontrollgruppe (n = 24) hatte nach Bedarf Midazolam, Pentazocin (Fortral®) oder Fentanylcitrat (Fentanyl®) erhalten. Ergebnisse: Analgosedierung war in allen Fällen jeweils von einem Radiologen und einer Assistenzperson durchführbar gewesen, in 69/72 Fällen wurde eine ausreichende Analgesie erreicht. Die Gabe von Alfentanil (Rapifen®) wurde titriert (0,4 - 2,5 mg). Das maximale Schmerzempfinden (0 - 10) der Patienten betrug durchschnittlich 2,6, in der Kontrollgruppe 4.5. Über 55 % der Patienten gaben keine oder nur geringe Schmerzen (score 0 - 3) an, in der Kontrollgruppe waren dies lediglich 8 %. Schlussfolgerungen: Der kombinierte Einsatz von kurzwirksamem Alfentanil und Midazolam ermöglicht interventionellen Radiologen eine effektive Analgosedierung von Patienten bei schmerzhaften interventionellen Eingriffen. Diese Form der Analgosedierung ist der Medikation bei Bedarf deutlich überlegen.
Abstract
Purpose: Development of a save and effective protocol for analgosedation of patients undergoing painful interventional procedures. Material and Methods: In a prospective trial a consecutive series of 72 adult patients underwent analgosedation during painful interventions. A radiologist performed the analgosedation, the patients received a combination of a shortly effective piperidine derivative (Alfentanil [Rapifen®]; 7.5 - 15 µg/kg body weight) and Benzodiazepine (midazolam [Dormicum®]; 20 µg/kg body weight). After pre-procedure oxygenation patients were continuously monitored. Pain and discomfort were scored using an established visual-analog pain score (0 - 10). A control group (n = 24) had received midazolam, pentazocine or fentanyl according to the study protocol. Results: All procedures could be carried out by an interventional radiologist and a nurse and/or technologist only. In 69/72 cases adequate analgosedation could be achieved. Injection of alfentanil was titrated, with a rapid onset and short acting effect of the analgesia. Patients reported an average pain score of 2.6 vs. 4.5 in the control group. Over 55 % experienced no or mild pain (score 0 - 3), in the control group only 8 % reached this level. Conclusion: A combination of shortly effective alfentanil and midazolam allows interventional radiologists to perform major procedures alone under effective analgosedation. This medication scheme is superior to the medication upon demand.
Schlüsselwörter
Sedierung - Analgosedierung - interventionelle Radiologie - minimalinvasiv - Schmerzbekämpfung - Alfentanil - Midazolam
Key words
Sedation - Sedoanalgesia - Pain control - Interventional procedure - Drugs - Alfentanil - Midazolam
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OA Dr. med. Ulrich Linsenmaier
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Nussbaumstraße 20
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Phone: 089-5160 9200
Fax: 089-5160 9202
Email: lin@ch-i.med.uni-muenchen.de
