Modeling Respiratory Depression Induced by Remifentanil and Propofol during Sedation and Analgesia Using a Continuous Noninvasive Measurement of pCO2

Remifentanil was a μ‐agonist, with a rapid onset, a powerful narcotic analgesic activity and a fast nonspecific esterases hydrolyzation and theoretically an ideal opioid for percutaneous dilatational tracheostomy (PDT). The present study discussed use of remifentanil in critically ill patients undergoing PDT. Ninety‐nine patients were randomly assigned to the propofol/remifentanil group (PR group, n = 49) or the propofol group (P group, n = 50). Two patients (one in P group and one in PR group) were excluded and transferred to surgical way of tracheostomy because of uncontrolled bleeding. The primary outcomes were critical care pain observation (CPOT) scores during PDT; hemodynamic response and side effects, such as bleeding and muscle rigidity (MR). CPOT scores in P group were significantly higher than in PR group during incision and dilation stages (P < 0.05 and P < 0.01). Systolic blood pressure had a significant drop after a bolus of remifentanil in PR group compared with patients in P group (P < 0.056). The incidence of MR was significantly higher in PR group than in P group (P < 0.05). Recovery time in PR group was significantly shorter than in P group (P < 0.05). The occurrence of tachycardia, bleeding, vomiting, and nausea had no statistically differences in both groups. Patients in PR group were undergoing shorter recovery time and better experience of pain in PDT compared with patients in P group, but MR seemed to be higher in PR group. Remifentanil seemed to be a safe and effective opioid used in critically ill patients undergoing PDT.

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“…MV hugely influences the variables, making the biases uncontrollable. That is the difference from other researches …”

Section: Discussionsupporting

confidence: 80%

“…That is the difference from other researches. [18][19][20] The total doses of propofol in PR group are significantly fewer than that used in P group. Patients in P group need more propofol to help control BP and ease the pain.…”

Section: Discussionmentioning

confidence: 99%

The use of remifentanil in critically ill patients undergoing percutaneous dilatational tracheostomy: A prospective randomized‐controlled trial

Chang

Sun

Feng

et al. 2019

The Kaohsiung J of Med Scie

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“…The result revealed that patients who with treatment of propofol decreased the incidence of other respiratory and circulatory diseases. This may explained that propofol had effect on airway smooth muscle reflexes [ 31 ]. Previous researches in the pediatric did not demonstrate the relationship between side effects and propofol/ketamine [ 32 – 37 ].…”

Section: Discussionmentioning

confidence: 99%

Incidence of Adverse Effects of Propofol for Procedural Sedation/Anesthesia in the Pediatric Emergency Population: A Systematic Review and Meta-Analysis

Guo

Ran

et al. 2021

Computational and Mathematical Methods in Medicine

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Background. To investigate the incidence of adverse effects of propofol among pediatric population for sedation or anesthesia. Methods. We performed Cochrane Library, PubMed, CNKI, VIP, and Wanfang databases to research relevant literature. We did sensitivity analysis to assess the incidence of adverse effects of propofol among pediatric population for sedation or anesthesia. Results. In 132 studies, eight RCTs were included in this analysis. The result showed that adverse events (bradypnea, hypotension, hypertension, and apnea) were significantly improved in the pediatric emergency population in the propofol group, but it had no effect on the incidence of cough attacks, desaturation, agitation, stridor, and laryngospasm. Furthermore, the subgroup analysis showed that those who received propofol for had decreased adverse effects compared with the patients who received ketamine treatment ( SMD = 0.44 , 95 % CI = 0.28 , 0.67 , I 2 = 0 %, and P = 0.0002 ), which demonstrated that propofol could decrease the incidence of adverse effects compared with ketamine and ketofol. Conclusions. The study demonstrated that propofol may decrease the incidence of bradypnea, hypotension, hypertension, and apnea, but it had no effect on the incidence of cough attacks, desaturation, agitation, stridor, and laryngospasm. Furthermore, more large RCTs are needed to assess incidence of adverse effects of propofol among pediatric population.

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“… Adapted from ( Ammar et al, 2021 ). References: [ Mahler and Forrest, 1975 ; Villiger et al, 1983 ; Yu and Sadée, 1988 ; Martin et al, 1991 ; Chiu et al, 1993 ; Lambert et al, 1993 ; Gozzani, 1994 , 1994 ; Fantoni et al, 1999 ; Lötsch, 2005 ; Vieweg et al, 2005 ; Hannam et al, 2016 , 2; Jeleazcov et al, 2016 ; Li et al, 2017 ; Palladone capsules 1.3 mg—Summary of Product Characteristics (SmPC)—(emc)] …”

Section: Resultsmentioning

confidence: 99%

Opioids in COVID-19: Two Sides of a Coin

et al. 2022

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Introduction: The treatment of most severe COVID-19 patients included the large-scale use of sedatives and analgesics–possibly in higher doses than usual–which was reported in the literature. The use of drugs that decrease mortality is necessary and opioids are important agents in procedures such as orotracheal intubation. However, these drugs seem to have been overestimated in the COVID-19 pandemic. We performed a review of the PubMed-Medline database to evaluate the use of opioids during this period. The following descriptors were used to enhance the search for papers: “Opioids”, “COVID-19,” “COVID-19 pandemic,” “SARS-CoV-2,” “Opioid use disorder,” “Opioid dependence” and the names of the drugs used. We also evaluated the distribution of COVID-19 patients in Brazil and the applicability of opioids in our country during the COVID-19 pandemic.Results: Several positive points were found in the use of opioids in the COVID-19 pandemic, for instance, they can be used for analgesia in orotracheal intubation, for chronic pain management, and as coadjutant in the management of acute intensification of pain. However, high doses of opioids might exacerbate the respiratory depression found in COVID-19 patients, their chronic use can trigger opioid tolerance and the higher doses used during the pandemic might result in greater adverse effects. Unfortunately, the pandemic also affected individuals with opioid use disorder, not only those individuals are at higher risk of mortality, hospitalization and need for ventilatory support, but measures taken to decrease the SARS-CoV-2 spread such as social isolation, might negatively affect the treatment for opioid use disorder. In Brazil, only morphine, remifentanil and fentanyl are available in the basic health care system for the treatment of COVID-19 patients. Out of the 5,273,598 opioid units used in this period all over the country, morphine, fentanyl, and remifentanil, accounted for, respectively, 559,270 (10.6%), 4,624,328 (87.6%), and 90,000 (1.8%) units. Many Brazilian regions with high number of confirmed cases of COVID-19 had few units of opioids available, as the Southeast region, with a 0.23 units of opioids per confirmed COVID-19 case, and the South region, with 0.05 units. In the COVID-19 pandemic scenario, positive points related to opioids were mainly the occurrence of analgesia, to facilitate intubation and their use as coadjutants in the management of acute intensification of pain, whereas the negative points were indiscriminate use, the presence of human immunosuppressor response and increased adverse effects due to higher doses of the drug.Conclusion: The importance of rational and individualized use of analgesic hypnotics and sedative anesthetics should be considered at all times, especially in situations of high demand such as the COVID-19 pandemic.

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Modeling Respiratory Depression Induced by Remifentanil and Propofol during Sedation and Analgesia Using a Continuous Noninvasive Measurement of pCO2

Cited by 18 publications

References 42 publications

The use of remifentanil in critically ill patients undergoing percutaneous dilatational tracheostomy: A prospective randomized‐controlled trial

The use of remifentanil in critically ill patients undergoing percutaneous dilatational tracheostomy: A prospective randomized‐controlled trial

Incidence of Adverse Effects of Propofol for Procedural Sedation/Anesthesia in the Pediatric Emergency Population: A Systematic Review and Meta-Analysis

Opioids in COVID-19: Two Sides of a Coin

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