Remifentanil conscious sedation during regional anaesthesia for carotid endarterectomy: rationale and safety

Objectives: to prospectively evaluate the safety and efficacy of remifentan il during regional anaesthesia for carotid endarterectomy. Methods. twenty-eight consecutive patients underwent carotid endarterectomy with combined superficial and deep cervical plexus block supplemented with continuous intravenous 0.04 mug(.)kg(-1.)min(-1) remifentanil infusion, De pth of sedation was monitored using the Observer's Assessment of Alertness/ Sedation Scale (OAA/S). The degree of pain, discomfort and anxiety was self -assessed by the patients using a horizontal visual analogue scale. Results: all patients experienced adequate comfort and analgesia. No local anaesthetic supplementation was necessary. No patient had a OAA/S score low er than 4 (with 5 = awake/alert to 1 = asleep). Respiratory depression did not occur, Selective shunting was required in four cases. No patient was co nverted to general anaesthesia. There were no permanent neurological defici ts, cardiopulmonary complications or deaths. Conclusion: remifentanil as a supplement to regional aneasthesia for caroti d endarterectomy, provides comfort and analgesia without hampering mental s tatus evaluation.