Comparison between remifentanil and other opioids in adult critically ill patients

Abstract

Background and aims: To identify the efficacy and safety of remifentanil when compared with other opioids in adult critically ill patients. Methods: We searched for studies in the Cochrane Library, MEDLINE, and EMBASE that had been published up to May 31st, 2019. Randomized clinical trials using remifentanil comparing with other opioids for analgesia were included. Two reviewers independently applied eligibility criteria, assessed quality, and extracted data. Duration of mechanical ventilation was the primary outcome, and secondary outcomes included weaning time, intensive care unit (ICU), length of stay (LOS), hospital LOS, mortality, side effects, and costs. Results: Fifteen studies with 1233 patients were included. Remifentanil was associated with a significant reduction in the duration of mechanical ventilation in the adult ICU patients when compared with other opioids ( P = .01). Remifentanil also reduced the weaning time ( P = .02) and the ICU LOS when compared with other opioids ( P = .01). There was no difference in the hospital LOS ( P = .15), side effects ( P = .39), and mortality ( P = .79) between remifentanil and other opioids, what's more, remifentanil increased the costs of anesthesia ( P < .001) but did not increase cost of hospitalization ( P = .30) when comparing with other opioids. Conclusions: Remifentanil reduced the duration of mechanical ventilation, weaning time, and ICU LOS when compared with other opioids in adult critically ill patients. Higher quality RCTs are necessary to prove our findings. PROSPERO registration number: CRD42016041438.

Remi-fent 1—A pragmatic randomised controlled study to evaluate the feasibility of using remifentanil or fentanyl as sedation adjuncts in mechanically ventilated patients

“…The results are broadly consistent with previous single-center studies from other countries that compared remifentanil to fentanyl, which have shown that remifentanil may be associated with shorter duration of mechanical ventilation, length of stay, and lower incidence of delirium. 26 , 29 , 30 , [36] , [37] , [38] , [39] , [40] , [41] , [42] However, our study has the largest sample size with a variable case-mix from a general ICU. Since it is the first study to be conducted in Australia, the results may be particularly relevant to Australian-New Zealand practice.…”

“… 6 , 11 In contrast, remifentanil is an ultra-short-acting opioid with a short context-sensitive half-life of 3–4 min. [22] , [23] , [24] , [25] , [26] , [27] Although clinical trials, systematic reviews, and meta-analyses have shown that the use of remifentanil may be associated with a reduction in the duration of mechanical ventilation and ICU length of stay, [28] , [29] , [30] its use in Australian ICUs is infrequent or rare. 31 While the reasons for this have not been explored, possible reasons could be attributed to the high cost of remifentanil until recently 7 and to the relative unfamiliarity with its use by intensivists with limited exposure to anaesthetic practice.…”

Sedation for Patients with Sepsis: Towards a Personalised Approach

“…Remifentanil is the opioid most consistently associated with the development of opioid-induced hyperalgesia (OIH) [38], a condition that must be distinguished from acute opioid withdrawal, and which presents particularly where opioid drugs have been used at high dosages over long time periods with an especially elevated incidence in younger patients. This condition may require the use of additional analgesics, and as a result may prolong the time spent on mechanical ventilation.…”

A review of key strategies to address the shortage of analgesics and sedatives in pediatric intensive care

“…▴ Remifentanil has single pharmacokinetic and pharmacodynamic profiles. Unfortunately, it is expensive compared to other conventional opioids ( 33 ). Current literature has demonstrated that an infusion of lidocaine effectively treats acute perioperative pain and various circumstances of chronic pain in pediatrics, particularly pain refractory to conventional regimens ( 34 , 35 ).…”