Recovery after remifentanil and sufentanil for analgesia and sedation of mechanically ventilated patients after trauma or major surgery

Abstract

We investigated the analgesic effect and the neurological recovery time after administration of remifentanil in mechanically ventilated patients in an intensive care unit. Twenty patients, after trauma or major surgery with no intracranial pathology, were randomized to receive either remifentanil/propofol (n=10) or sufentanil/propofol (n=10). A sedation score and a simplified pain score were used to assess adequate sedation and analgesia. Medication was temporarily stopped after 24 h. Immediately before and 10 and 30 min after, the degree of sedation and pain score were evaluated. Adequate analgesia and sedation was achieved with remifentanil 10.6 microg kg(-1) h(-1) and propofol 2.1 mg kg(-1) h(-1), or sufentanil 0.5 microg kg(-1) h(-1) and propofol 1.3 mg kg(-1) h(-1). The difference in propofol dose between groups was significant. Ten minutes after terminating the medication, the degree of sedation decreased significantly after remifentanil and all patients could follow simple commands. During the following 20 min, all patients with remifentanil emerged from sedation and complained of considerable pain. By contrast, in the sufentanil group, only six (7) responded to commands after 10 (30) min and their pain score remained essentially unchanged during the 30-min observation period. We conclude that, in contrast to sufentanil, remifentanil facilitates rapid emergence from analgesia and sedation, allowing a clinical neurological examination within 10-30 min in mechanically ventilated patients with no intracranial pathology.

Remifentanil and Fentanyl Use and the Liver Function Tests

“…However, the influence of IV anesthetics on hepatic functions is not well established; therefore, it was our goal to determine the effects of TIVA with propofol-remifentanil or propofol-fentanyl on postoperative hepatic functions and to compare their relative safety. Recovery times in group R was significantly shorter than in group F. Soltész et al, [24] also reported faster recovery when using remifentanil than sufentanil. Unlike existing opioids, remifentanil is rapidly metabolized by nonspecific blood and tissue esterases [25] into a clinically inactive metabolite.…”

Effects of maintaining intravenous infusion of remifentanil or propofol on anesthesia and palinesthesia during anesthesia and analepsia

“…Its elimination half-life is 3-5 min (Hughes et al, 1992;Kapila et al, 1995;Soltesz et al, 2001). It has been reported (Soltesz et al, 2001;Albertin et al, 2005Albertin et al, , 2006 that remifentanil, combined with other anesthetics at a target concentration of 1-3 ng/mL in the plasma, can inhibit the sympathetic response in 50% of patients when the skin is incised. A target concentration of 4 ng/mL remifentanil is required for intubation, and the target concentration is maintained at 2-5 ng/mL during surgery.…”

“…After discontinuation, patients can quickly regain consciousness. It has been widely used in clinical anesthesia (Hughes et al, 1992;Kapila et al, 1995;Soltesz et al, 2001). Recent studies have shown that the use of remifentanil can benefit patients who are awake (Shajar et al, 1999;Wilhelm et al, 2001;Hohlrieder et al, 2007).…”

Complications de la sédation

“…Ils peuvent être corrigés par la méthylnaltrexone (18), dont l'efficacité en réanimation n'a cependant pas encore été évaluée. Chez les patients polytraumatisés ou chirurgicaux, un syndrome d'hyperalgésie peut être observé très rapidement à l'arrêt du rémifentanil, nécessitant l'administration préalable de morphine (19).…”