Remifentanil and fentanyl during anaesthesia for major abdominal and gynaecological surgery. An open, comparative study of safety and efficacy

Abstract

Background and objectiveThis open, multicentre study compared the ef®cacy and safety of remifentanil with fentanyl during balanced anaesthesia with 0.8% iso¯urane (end-tidal concentration) for major abdominal and gynaecological surgery, and the ef®cacy and safety of remifentanil for pain management in the immediate postoperative period. Methods Two-hundred and eighty-six patients were randomized to receive remifentanil 1 lg kg ±1 followed by 0.2 lg kg ±1 min ±1 (n 98), remifentanil 2 lg kg ±1 followed by 0.4 lg kg ±1 min ±1 (n 91) or fentanyl 3 lg kg ±1 (n 97) at induction. Thereafter, the study opioids and iso¯urane were titrated to effect during the operation. Results Compared with fentanyl, remifentanil 2 lg kg ±1 followed by 0.4 lg kg ±1 min ±1 reduced the incidence of response to tracheal intubation (30% vs. 13%, P < 0.01), skin incision (33% vs. 4%, P < 0.001) and skin closure (11% vs. 3%, P < 0.05), respectively. Patients receiving remifentanil 1 lg kg ±1 followed by 0.2 lg kg ±1 min ±1 had fewer responses to skin incision than the fentanyl group (12% vs. 33%, P < 0.001), but the incidences of response to tracheal intubation and skin closure were similar. Signi®cantly

Intraoperative use of remifentanil and opioid induced hyperalgesia/acute opioid tolerance: systematic review

“…Therefore, remifentanil bolus alone is not enough to attenuate the responses and the use of a bolus-infusion regimen is required (McAtamney et al, 1998). The commonly accepted and recommended dose of remifentanil is 1 μg/kg followed by an infusion of 0.5–1 μg/kg/min for induction of anesthesia or 0.05–2.0 μg/kg/min for maintenance of anesthesia (Burkle et al, 1996; Hall et al, 2000; Sneyd et al, 2001). In postoperative period, remifentanil continuous infusion (CI) also can be used for controlling the pain, and the final remifentanil infusion rates have been reported as 0.05–0.26 μg/kg/min for satisfactory analgesia after surgery (Bowdle et al, 1996, 1997; Schuttler et al, 1997; Yarmush et al, 1997; Sneyd et al, 2001).…”