Remifentanil for percutaneous tracheostomies in ITU

Gupta, S.; Ravalia, A.

doi:10.1046/j.1365-2044.2000.01425-7.x

Cited by 6 publications

(3 citation statements)

References 4 publications

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“…The unique pharmacological profile of remifentanil has proved particularly advantageous in neurotrauma patients [13-15], patients with renal impairment [16-18], cardiac postsurgical patients [19], general postsurgical patients [20], and patients with chronic obstructive pulmonary disease and other respiratory complications [21,22]. Because of the rapid and predictable mode of metabolism, use of high doses of remifentanil has also been investigated in patients undergoing short, painful procedures [13,23,24]. Comparator studies have also been reported that confirm the rapid and predictable recovery that is achieved when using remifentanil [14,15,21,25].…”

Section: Introductionmentioning

confidence: 99%

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et al. 2004

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Correspondence: Bernd Muellejans, dr.muellejans@drguth.de R1 HR = heart rate; ICU = intensive care unit; MAP = mean arterial pressure; PI = Pain Intensity (scale); SAPS = Simplified Acute Physiology Score; SAS = Sedation-Agitation Scale; SD = standard deviation. AbstractIntroduction This double-blind, randomized, multicentre study was conducted to compare the efficacy and safety of remifentanil and fentanyl for intensive care unit (ICU) sedation and analgesia. Methods Intubated cardiac, general postsurgical or medical patients (aged ≥18 years), who were mechanically ventilated for 12-72 hours, received remifentanil (9 µg/kg per hour; n = 77) or fentanyl (1.5 µg/kg per hour; n = 75). Initial opioid titration was supplemented with propofol (0.5 mg/kg per hour), if required, to achieve optimal sedation (i.e. a Sedation-Agitation Scale score of 4). Results The mean percentages of time in optimal sedation were 88.3% for remifentanil and 89.3% for fentanyl (not significant). Patients with a Sedation-Agitation Scale score of 4 exhibited significantly less between-patient variability in optimal sedation on remifentanil (variance ratio of fentanyl to remifentanil 1.84; P = 0.009). Of patients who received fentanyl 40% required propofol, as compared with 35% of those who received remifentanil (median total doses 683 mg and 378 mg, respectively; P = 0.065). Recovery was rapid (median time to extubation: 1.1 hours for remifentanil and 1.3 hours for fentanyl; not significant). Remifentanil patients who experienced pain did so for significantly longer during extubation (6.5% of the time versus 1.4%; P = 0.013), postextubation (10.2% versus 3.6%; P = 0.001) and post-treatment (13.5% versus 5.1%; P = 0.001), but they exhibited similar haemodynamic stability with no significant differences in adverse event incidence. Conclusion Analgesia based sedation with remifentanil titrated to response provided effective sedation and rapid extubation without the need for propofol in most patients. Fentanyl was similar, probably because the dosing algorithm demanded frequent monitoring and adjustment, thereby preventing over-sedation. Rapid offset of analgesia with remifentanil resulted in a greater incidence of pain, highlighting the need for proactive pain management when transitioning to longer acting analgesics, which is difficult within a double-blind study but would be quite possible under normal circumstances.

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Section: Introductionmentioning

confidence: 99%

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et al. 2004

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“…The organ independent metabolism is one of the most significant advantages of remifentanil in patients with liver impairment. Gupta et al, [20] reported that remifentanil was observed as an effective drug in patients undergoing short, painful procedures. Fentanyl's effects begin within 2 to 3 minutes of administration; its duration of action is 30 to 60 minutes [7].…”

Section: Discussionmentioning

confidence: 99%

Remifentanil and Fentanyl Use and the Liver Function Tests

Mızrak¹

2012

Ann Clin Anal Med

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“…7 The potential of remifentanil to achieve hemodynamic stability is ideally suited to manage episodes of stimulation associated with many procedures, such as line insertion, intubation or extubation, and a percutaneous tracheostomy. [8][9][10] Remifentanil may cause a decrease in both cerebral metabolic rate and intracranial pressure, with minimal changes in the cerebral perfusion pressure and cerebral blood flow. [11][12][13][14] Cerebral autoregulation and carbon dioxide reactivity are preserved with remifentanil.…”

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confidence: 99%

Comparison of Dexmedetomidine, Remifentanil, and Esmolol for the Control of Hypertension During Tracheal Extubation and Emergence From Anesthesia After a Craniotomy

Güneş¹,

Türktan²,

Erman

et al. 2013

Neurosurgery Quarterly

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Hypertension has been reported during emergence from anesthesia to be >90% in neurosurgical patients. We examined the effects of dexmedetomidine, remifentanil, and esmolol infusion on recovery profiles and cardiovascular responses of patients during the emergency period after a craniotomy. ASA I to III physical status patients, who were undergoing intracranial surgery for either vascular or spaceoccupying lesions, were eligible if aged between 17 and 65 years. Anesthesia was induced using propofol and dexmedetomidine and maintained using sevoflurane and dexmedetomidine infusion. Patients were randomly allocated in 3 groups. Dexmedetomidine infusion was continued until the initiation of skin closure in group D. Dexmedetomidine infusion was discontinued in other groups after placing the bone graft. Thereafter, remifentanil infusion (0.25 mg/kg/min) or esmolol infusion (0.25 mg/kg/min) were started in the other groups (group R or E) until the initiation of skin closure. Extubation time, recovery time, incidence of coughing during extubation, and hemodynamic variables during the emergence phase were recorded. During the emergence phase, the systolic and mean arterial blood pressures and heart rates were similar compared with baseline values in all study groups. The median extubation time was similar in the dexmedetomidine (4.9 min), remifentanil (3.9 min), and esmolol groups (2.7 min). The incidence of cough was similar in the dexmedetomidine group compared with the remifentanil or esmolol groups. Time to eye opening, time to orientation, and response to verbal command were longer in the dexmedetomidine group compared with the remifentanil group. We concluded that remifentanil, dexmedetomidine, and esmolol infusion can be used to control blood pressure during emergence from anesthesia after a craniotomy.

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Remifentanil for percutaneous tracheostomies in ITU

Cited by 6 publications

References 4 publications

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Remifentanil and Fentanyl Use and the Liver Function Tests

Comparison of Dexmedetomidine, Remifentanil, and Esmolol for the Control of Hypertension During Tracheal Extubation and Emergence From Anesthesia After a Craniotomy

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