High-dose Remifentanil Does Not Impair Cerebrovascular Carbon Dioxide Reactivity in Healthy Male Volunteers

Abstract

High-dose remifentanil decreases rCBF and mean CBFv without impairing cerebrovascular carbon dioxide reactivity. This, together with its known short duration of action, makes remifentanil a useful agent in the intensive care unit when sedation that can be titrated rapidly is required.

Influence of general anaesthesia on slow waves of intracranial pressure

“…9,11,20 Patients in the TBI group were carefully selected to not have significant intracranial hypertension (ICp < 18 mm Hg) and their CSF parameters were considered for the first day of their admission. B-waves are disturbed and disappear in cases where autoregulation has failed and ICP has risen severely and therefore the difference in slow wave magnitude cannot most probably be due to the TBI itself rather than the fact that patients were sedated.…”

“…25,26 The safety of fentanyl and remifentanil as adjuvants in neuroanaesthesia and neurointensive care is also supported by a large body of evidence. [18][19][20][21] The impact of neuromuscular blockers on CSF dynamics is negligible. 20,21 Nonetheless, the current study demonstrates that even propofol-based anaesthesia and sedation are associated with a considerable reduction of approximately 50% in the amplitude of vasogenic waves when compared to wakefulness or natural sleep.…”

“…[18][19][20][21] The impact of neuromuscular blockers on CSF dynamics is negligible. 20,21 Nonetheless, the current study demonstrates that even propofol-based anaesthesia and sedation are associated with a considerable reduction of approximately 50% in the amplitude of vasogenic waves when compared to wakefulness or natural sleep. The iatrogenic influence is most likely to be multifactorial, with plausible factors being direct pharmacological effect and suppression of cerebral metabolic is affected by iatrogenic suppression of slow vasogenic waves of ICP.…”

“…[17][18][19] All patients presented with ventriculomegaly and with at least two elements of Hakim Triad symptoms (urinary incontinence, shuffling gait and memory loss); gait problems were present in all patients. Anaesthesia during the infusion study was induced using propofol, fentanyl and atracurium or vecuronium [20][21][22] and maintained with either propofol target-controlled infusion 3-6 mcg/ml effect site alone or combined with remifentanil 0.05-0.2 mcg/kg/ min. Body temperature and CO2 levels were recorded and controlled at 36-37 °C and 4.5-5.0 kPa, respectively, as part of standard local practice.…”

Anesthetic management of labor and delivery in patients with elevated intracranial pressure

“…68 Remifentanil infusions in healthy volunteers decrease CBF. 69 The successful use of remifentanil as an adjunct to general anesthesia has been reported in patients with preeclampsia and HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome. 70,71 Due to the unpredictable neonatal effects of remifentanil, physicians trained in neonatal resuscitation should be present at delivery.…”