• R Blancas Gómez-Casero, C Martín Delgado, E Nevado Losada, M Quintana Díaz, M Chana García, B López Matamala, J Serrano Castañeda, and J L González Manzanares.
• Unidad de Cuidados Intensivos, Hospital General La Mancha-Centro, Alcázar de San Juan, Ciudad Real, España. rblancasg@sescam.jccm.es
• Med Intensiva. 2006 Nov 1; 30 (8): 370-3.

ObjectiveDescribe the use of remifentanil in definitive pacemaker implant.DesignProspective, observational study.ScopeIntensive Care Unit of two general hospitals.PatientsNinety-four patients subjected to DPM implant under sedation with remifentanil.InterventionsThe protocol for DPM implant was conducted: premedication with metoclopramide, remifentanil perfusion (20 micro g/ml), local infiltration with mepivacaine 2%, administration of magnesium metamizole at the end of the implant and posterior discontinuation of remifentanil. Remifentanil perfusion was initiated at 2 micro g/minute, increasing it until reaching a sedation grade 2-3 on the Ramsay scale, with a maximum of 6 micro g/minute. MAIN ENDPOINTS: Time needed to reach the desired sedation grade and duration of sedation, maximum dose of remifentanil necessary, frequency that another sedation was needed and of adverse events were recorded. Continuous quantitative endpoints were expressed as mean +/- SD.ResultsA sedation grade 2-3 was achieved with a perfusion rhythm of 3.6 +/- 1.4 micro g/min, in 20 +/- 22 minutes. In 89 patients (94.6%), the implant was performed only with remifentanil. Frequency of adverse events were nauseas/vomiting 21.3%, hypotension 5.3% and respiratory depression 1%. Remifentanil perfusion was discontinued in 3 patients (3.2%) due to appearance of adverse events. Another sedoanalgesic was used in 2 patients (2.1%).ConclusionsRemifentanil is useful in the implant of DPM as a sedoanalgesia method. Serious undesired effects are rare. Future studies are necessary to completely establish its effectiveness and safety in these types of procedures.

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