Problems in obtaining sufficient anaesthesia with propofol and remifentanil: three cases, a test infusion, and a review

Bache, Søren; Stendell, L.; Olsen, Niels Vidiendal; Olsen, K.S.

doi:10.1093/bja/aes474

Cited by 6 publications

(5 citation statements)

References 23 publications

(15 reference statements)

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“…A lack of clinical effect closer to that which we observed has recently been described in adults [9]. Bache reported three adult patients who, over a five year period, underwent seven anaesthetics between them where they did not appear to demonstrate the normal clinical effect of remifentanil.…”

Section: Discussionsupporting

confidence: 81%

A case report of apparent remifentanil resistance in a paediatric patient

Wrigley

Murphy

2016

Anaesthesia Cases

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We present the case of a three-year-old patient undergoing cardiac magnetic resonance imaging who demonstrated a non-typical response to a remifentanil infusion. Following exclusion of common reasons for apparent remifentanil 'failure', including correct drug preparation and delivery, we consulted the literature for other possible causes. We suggest there may be a sub-group of patients who are either outliers in the dose response curve or who are truly 'resistant' to certain pharmacodynamic effects of remifentanil in both adult and paediatric practice.

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Section: Discussionsupporting

confidence: 81%

A case report of apparent remifentanil resistance in a paediatric patient

Wrigley

Murphy

2016

Anaesthesia Cases

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“…The present results showed that remifentanil induced more stable hemodynamics than sufentanil . This difference in hemodynamics may be associated with the more effective dose‐dependent inhibition of sympathetic activity by remifentanil than by other opioids …”

Section: Discussionsupporting

confidence: 49%

Remifentanil inhibits the traumatic stress response in emergent trauma surgery

Ouyang

Ren

Liu

et al. 2019

Clinical Laboratory Analysis

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ObjectiveThe aim of this study was to explore whether remifentanil could inhibit the stress response in emergent trauma surgery more effectively than sufentanil.Patients and methodsSixty trauma patients for emergent surgery were randomly divided into remifentanil group (R group, n = 30) or sufentanil group (S group, n = 30). The patients in the R group were continuously intravenously infused with remifentanil, while those in the S group were administrated with sufentanil. The plasma contents of cortisol (COR), epinephrine (E), norepinephrine (NE), and blood glucose were measured before anesthesia induction (T1), 5 minutes after intratracheal intubation (T2) and 5 minutes (T3), 30 minutes (T4), and 1 hour (T5) after surgery, respectively. The blood pressure (BP) and the heart rate (HR) at these time points were recorded as well.ResultsThe results showed that the patients in the R group had more stable hemodynamics during the surgery and had a significantly lower HR at T2‐T5 than those in the S group. The plasma levels of norepinephrine at time points T3‐T5 and levels of cortisol at T4‐T5 in the R group were significantly lower than those in the S group (P < 0.05).ConclusionsThe results in the present study indicated that remifentanil could inhibit the stress response in emergent trauma surgery patients more effectively than sufentanil.

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“…In a patient who was treated for narcolepsy with modafinil, inhalation anesthetics had to be used because anesthesia could not be achieved (BIS was 72) after induction with 6 mg/kg of propofol[ 3 ]. Bache et al [ 4 ] reported insufficient anesthetic effects of propofol and remifentanil for general anesthesia in three cases over 5 years and suspected the possibility of acute tolerance to remifentanil. In this case, the patient had no medical or drug history and the BIS decreased to 35 after the administration of IV anesthetics; therefore, resistance to propofol and acute tolerance to remifentanil can be excluded.…”

Section: Discussionmentioning

confidence: 99%

Uncontrolled high blood pressure under total intravenous anesthesia with propofol and remifentanil: A case report

Jang¹,

Kim²,

Jeong³

2022

WJCC

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BACKGROUND Although propofol generally reduces blood pressure, rarely, it causes hypertension. However, the mechanism by which propofol increases blood pressure has not been established, and so far, there are only a few reported cases. CASE SUMMARY A 46-year-old woman, diagnosed with thyroid cancer, was administered general anesthesia with propofol and remifentanil for a thyroid lobectomy. An increase in the concentrations of intravenous anesthetics further increased her blood pressure. The blood pressure remained stable when anesthesia was maintained with sevoflurane and remifentanil after the interruption of propofol administration. CONCLUSION We concluded that propofol administration was the cause of increased blood pressure.

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Problems in obtaining sufficient anaesthesia with propofol and remifentanil: three cases, a test infusion, and a review

Abstract: The potential causes of this effect are discussed. We advise clinicians to be aware of this unusual response to remifentanil. If such a response is suspected, we recommend the use of another opioid. If this is suspected before GA, we propose the use of our test as a diagnostic tool.

Cited by 6 publications

References 23 publications

A case report of apparent remifentanil resistance in a paediatric patient

A case report of apparent remifentanil resistance in a paediatric patient

Remifentanil inhibits the traumatic stress response in emergent trauma surgery

Uncontrolled high blood pressure under total intravenous anesthesia with propofol and remifentanil: A case report

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