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

Sneyd, J. R.; Camu, F.; Doenicke, Α.; Mann, Christine; Holgersen, O.; Helmers, J. H. J. H.; Appelgren, L.; Noronha, D.; Upadhyaya, B. K.

doi:10.1046/j.1365-2346.2001.00929.x

Cited by 9 publications

(6 citation statements)

References 23 publications

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“…We were able to retrieve 220 articles, 104 of which met the inclusion criteria [6][7][8][9][10][11][12][13][14][15][16][17][18][19]. We eliminated 116 of the retrieved studies for the following reasons: two were review articles, 10 did not compare remifentanil with other opioids, nine were not randomised trials, 37 did not have relevant data or had data that could not be extrapolated from the published graphs, five did not mention the number of patients per group, 11 did not use general anaesthesia, 10 included data from children (age less than 18 years) and 20 used different anaesthetics in the remifentanil and comparator group.…”

Section: Resultsmentioning

confidence: 99%

“…However, we included studies in which rigid bronchoscopy or laryngoscopy was conducted under general anaesthesia without intubation. If remifentanil use extended into the postoperative period, we only extracted the intra-operative data [11][12][13][14][15][16][17][18][19]. Reports were excluded if remifentanil was used for sedation and analgesia for patients in the intensive care unit.…”

Section: Methodsmentioning

confidence: 99%

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Remifentanil for general anaesthesia: a systematic review

et al. 2007

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SummaryWe performed a quantitative systematic review of randomised, controlled trials that compared remifentanil to short-acting opioids (fentanyl, alfentanil, or sufentanil) for general anaesthesia. Eighty-five trials were identified and these included a total of 13 057 patients. Intra-operatively, remifentanil was associated with clinical signs of deeper analgesia and anaesthesia, such as fewer responses to noxious stimuli (relative risk 0.65, 95% CI 0.48-0.87), more frequent episodes of bradycardia (1.46, 1.04-2.05), more hypotension (1.68, 1.36-2.07) and less hypertension (0.60, 0.46-0.78). Postoperatively, remifentanil was associated with faster recovery (difference in extubation time of )2.03, 9.5% CI, )2.92 to

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Remifentanil for general anaesthesia: a systematic review

et al. 2007

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“…Hypotension is a common side effect encountered during sedative/analgesic infusions administered as adjuncts of inhaled volatile and intravenous agents. Remifentanil infusions have been associated with high incidences of hypotensive episodes when compared to other opioids such as fentanyl21. Dexmedetomidine has been shown to have a lower incidence of hypotension when used peri-operatively22.…”

Section: Introductionmentioning

confidence: 99%

A comparison of risk of hypotension using standard doses of remifentanil versus dexmedetomidine infusions in adult patients undergoing surgery under general anaesthesia at the Aga Khan University Hospital, Nairobi

Okello¹,

Mung’ayi²,

Adam³

et al. 2018

Afr H. Sci.

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BackgroundRemifentanil and dexmedetomidine are common agents used in general anaesthesia, monitored anaesthesia care and critical care. When combined with inhaled or intravenous anaesthetic agents intra-operatively, they provide analgesia, lower general anaesthetic requirements and provide sedation and analgesia in the peri-operative period if indicated. Pharmacodynamically, they cause hypotension and bradycardia which are reversible if well managed. Past studies of these drugs have shown a significant proportion of patients with hypotension when compared with similar agents or in isolation. This study compares these two drugs on the effect of hypotension when used as adjuncts to general anaesthesia at low dose standard rate of infusions.ObjectiveTo compare the proportion of hypotension episodes in a group of adult patients receiving dexmedetomidine infusion at 0.4mcg/kg/hr versus a group receiving remifentanil infusion at 0.2mcg/kg/min, severity of hypotension and physician interventions in each group.MethodsOne hundred and four patients scheduled for elective surgery under general anaesthesia were randomized into two groups: Control group; received remifentanil infusion at 0.2mcg/kg/minIntervention group; received dexmedetomidine at 0.4mcg/kg/hr.General anaesthesia was standardized in both groups. The patients were blinded to the study. Baseline blood pressures of all patients were determined prior to induction. The patient's demographic characteristics were recorded. The number of patients who developed hypotension, the frequency of hypotension and the physician interventions were recorded and analysed.ResultsThe age and gender characteristics were different between the two groups (p values <0.023 and 0.05 respectively) however they did not affect the proportion of patients with hypotension. The weight, baseline pressures and ASA status of the patients within the groups were similar. The operative procedures varied within the groups. General surgery did not influence the outcome of hypotension in both arms. The duration of surgery in remifentanil group exceeded that of Dexmedetomidine p value<0.0005 however the time to the first episode of hypotension was similar between the groups. The episodes of hypotension were fewer in the dexmedetomidine arm and the proportion of patients with hypotension were higher in the remifentanil arm, p value<0.001, R.R 0. = 0.5938, 95% C.I= 0.329–0.819 The physician interventions administered were similar between the two groups except the use of ephedrine between the groups.ConclusionAmong this population, at standard infusion rates, the proportion of patients that risk hypotension was greater in those undergoing elective surgery receiving remifentanil at 0.2mcg/kg/min than in dexmedetomidine at 0.4mcg/kg/hr under isoflurane based anaesthesia.

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“…with a regional technique). Clinically, remifentanil titratability translates into a better control over adrenergic stimuli whatever the type of surgery or the patients (Kapila et al 1995;Mouren et al 2001;Schuttler et al 1997;Cartwright et al 1997;Gemma et al 2002;Guy et al 1997;Howie et al 2001;McGregor et al 1998;Sneyd et al 2001;Ahonen et al 2000;Balakrishnan et al 2000;Casati et al 2000;Doyle et al 2001;Fleisher et al 2001;Natalini et al 1999;Twersky et al 2001;Wee et al 1999;Wilhelm et al 2001). For example, intubation is a stronger stimulus than laryngoscopy, which in turn is stronger than skin incision.…”

Section: Control Over Intra-operative Stimulimentioning

confidence: 99%

Remifentanil and Other Opioids

Servin

Billard

Handbook of Experimental Pharmacology

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Most opioids used in anaesthesia are of the anilidopiperidine family, including fentanyl, alfentanil, sufentanil and remifentanil. While all share similar pharmacological properties, remifentanil, the newest one, is probably the most original, which is the reason this review focusses especially on this drug. Remifentanil is a potent mu-agonist that retains all the pharmacodynamic characteristics of its class (regarding analgesia, respiratory depression, muscle rigidity, nausea and vomiting, pruritus, etc.) but with a unique pharmacokinetic profile that combines a short onset and the fastest offset, independent of the infusion duration. Consequently, it offers a unique titratability when its effects need to be quickly achieved or suppressed, but it requires specific drug delivery schemes such as continuous infusion, target-controlled infusion and anticipated postoperative pain treatment. Kinetic differences between opioids used in anaesthesia and some clinical uses of remifentanil are reviewed in this chapter.

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

Cited by 9 publications

References 23 publications

Remifentanil for general anaesthesia: a systematic review

Remifentanil for general anaesthesia: a systematic review

A comparison of risk of hypotension using standard doses of remifentanil versus dexmedetomidine infusions in adult patients undergoing surgery under general anaesthesia at the Aga Khan University Hospital, Nairobi

Remifentanil and Other Opioids

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