Remifentanil for procedural sedation: a systematic review of the literature

Kisilewicz, Magdalena; Rosenberg, Hans; Vaillancourt, Christian

doi:10.1136/emermed-2016-206129

Cited by 18 publications

(12 citation statements)

References 24 publications

(19 reference statements)

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“…However, the propofol/fentanyl group showed a lower success rate in muscle relaxation and a higher rate of apnea (55). These findings were confirmed by similar studies (81)(82)(83). In the study by Kasmaee et al, agitation and apnea were observed in 25% and 9.4% of the patients in the propofol/fentanyl group, respectively; the frequency of apnea was 32% in the remifentanil group (55).…”

Section: Propofol/fentanyl Versus Remifentanilsupporting

confidence: 67%

Midazolam, Etomidate, Propofol, Fentanyl, Ketamine, and Propofol/Ketamine for Procedural Sedation and Analgesia Among Adults in the Emergency Departments: A Systematic Review

et al. 2020

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: The current systematic review aimed at investigating different medications commonly used for procedural sedation and analgesia (PSA) in emergency departments (EDs) for adults. The articles related to the subject of interest were searched in five electronic databases, including Google Scholar, PubMed, Medline, Web of Science, Scopus, and Embase, up to 2019. The blinded, randomized, controlled, clinical trials comparing common PSA medications, including midazolam, etomidate, propofol, fentanyl, ketamine, and ketofol, among the adults undergoing PSA in EDs were included in the study. The search process resulted in the inclusion of 35 papers in the study. The main information, including clinical features, sedation duration, recovery time, and incidence of adverse events, was extracted from the selected studies. Based on the reviewed studies, various combinations of medications are used for PSA depending on the hospital protocols and policies; however, there is still controversy over the best choice. As the results of the retrieved articles indicated, propofol is the most common medication used for PSA in EDs due to the shorter time of induction, rapid recovery of consciousness, and fewer side effects. Etomidate and ketamine were also identified as other common sedatives applied for PSA.

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Section: Propofol/fentanyl Versus Remifentanilsupporting

confidence: 67%

Midazolam, Etomidate, Propofol, Fentanyl, Ketamine, and Propofol/Ketamine for Procedural Sedation and Analgesia Among Adults in the Emergency Departments: A Systematic Review

et al. 2020

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“…In the current study, the low incidence of nausea, vomiting, and chest congestion in patients administered remifentanil was due to its inhibitory effects on carboprost-induced smooth muscle contraction (Holzer, 2009) as well as its sedation effects (Kisilewicz et al, 2017). In the clinic, we observed that the remifentanil's antiemetic benefit was better than usual antiemetics given at the time of carboprost because the rapid onset of remifentanil and latency effect of usual antiemetics.…”

Section: Discussionmentioning

confidence: 47%

“…In parturient patients treated with remifentanil, the need for rescue analgesia (with sufentanil) and the maximal VAS scores were both reduced. The sedation and analgesic effects of remifentanil (Kisilewicz et al, 2017) and the reduced incidence of carboprost side effects contributed to improved comfort and satisfaction of the mothers in group R compared with those in group C. Furthermore, the mean minimum RRs and the mean minimum SpO 2 were both within normal ranges. Studies have shown that remifentanil can be safely used during labor analgesia, with few side effects on the fetus (Ohashi et al, 2016;Wilson et al, 2018).…”

Section: Discussionmentioning

confidence: 88%

Remifentanil for Carboprost-Induced Adverse Reactions During Cesarean Delivery Under Combined Spinal-Epidural Anesthesia

et al. 2020

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Purpose: Carboprost may induce adverse reactions when used to treat postpartum hemorrhage. We aimed to explore the effects of intravenous infusion of low-dose remifentanil to prevent such reactions. Methods: We enrolled parturient patients scheduled for elective cesarean section. Anesthesiologist administered combined spinal epidurals at the L3/4 interspace, with 0.5% hyperbaric bupivacaine subarachnoid space injections (1.5-2.5 ml). We randomly divided parturient patients, administered carboprost during surgery, into the remifentanil group (group R) and the control group (group C). Patients in group R received an intravenous targetcontrolled infusion of remifentanil (target effect-site concentration, 1.5 ng/ml) simultaneously with a carboprost tromethamine injection (250 µg). Patients in group C received a normal saline infusion with carboprost. We recorded and analyzed the incidence of carboprostrelated adverse reactions (vomiting, nausea, chest congestion, flushing, hypertension, tachycardia, cough, and shivering), and assessed patient comfort using a numerical rating scale ([NRS], on which 0 was very uncomfortable and 10 was very comfortable). Results: After applying inclusion and exclusion criteria, we conducted statistical analysis of the data from 70 women. The incidence of vomiting was significantly lower in group R than in group C (14.3 vs. 51.4%, p < 0.01); and the incidence of nausea, chest congestion, facial flushing, and hypertension were significantly lower in group R than in group C (all p < 0.01). Furthermore, the patients' comfort scores were significantly higher in group R than in group C (8.0 ± 1.8 vs. 3.6 ± 2.1, p < 0.01). Conclusion: Our results demonstrate that an intravenous low-dose remifentanil infusion can effectively prevent carboprost-related adverse reactions during cesarean delivery under combined spinal and epidural anesthesia. Clinical Trial Registration: We pre-registered this study at http://www.chictr.org.cn/ showproj.aspx?proj=27707 (ChiCTR1800016292).

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“…In clinical general anesthesia, propofol combined with remifentanil is mainly used for drug compatibility, which has the advantages of rapid anesthesia and postoperative recovery ( 15 , 16 ). Propofol ( 17 ) can be rapidly removed from the central ventricle through liver metabolism and renal excretion, while remifentanil ( 18 , 19 ) can be rapidly degraded by non-specific esterase, which was advantageous in rapid action, short action time, rapid removal without accumulation during continuous infusion. Inhalation anesthesia also has advantages including quick effect and discharge, little influence on circulation and respiration, and non-invasive administration.…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy of intravenous anesthesia on breast segmental surgery and its effects on oxidative stress response and hemodynamics of patients

Zhou

Zheng

et al. 2020

Exp Ther Med

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This study was designed to investigate the clinical efficacy of intravenous anesthesia on breast segmental surgery and the effects on hemodynamics of patients. A total of 267 patients were collected as research subjects. These patients underwent breast segmental surgery in Chun'an First People's Hospital from March 2015 to September 2018. Among them, 137 patients undergoing intravenous anesthesia were the research group, and 130 patients undergoing inhalation anesthesia were the control group. The following parameters were recorded: Clinical efficacy, postoperative adverse conditions, hemodynamic indicators including systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR). Visual analogue scale (VAS) was used to observe the analgesic effect of the two groups, the mental state of patients in the two groups was observed by mini-mental state examination (MMSE) scoring method, and systemic evaluation was made by oxidative stress (OS) reaction indicators. The MMSE scores of the two groups decreased one day after surgery, but the score in the research group was higher than that in the control group (P<0.05). The levels of SBP and DBP at T1 and T2 in the control group were significantly higher than those in the research group (P<0.05). HR of research group at T1 and T2 was lower than that at T0 and that at corresponding time of control group (P<0.05). The incidence rate of postoperative adverse reactions in the research group was significantly lower than that in the control group (P<0.05). In conclusion, intravenous anesthesia for breast segmental surgery can reduce the occurrence of adverse reactions after surgery, with complete sedation and analgesia. Patients were able to wake up quickly and stably after surgery, and their cognitive function and OS recovered rapidly. However, due to the great impact on hemodynamics during surgery, attention should be paid to maintain hemodynamic stability during surgery to avoid hypotension and bradycardia.

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Remifentanil for procedural sedation: a systematic review of the literature

Cited by 18 publications

References 24 publications

Midazolam, Etomidate, Propofol, Fentanyl, Ketamine, and Propofol/Ketamine for Procedural Sedation and Analgesia Among Adults in the Emergency Departments: A Systematic Review

Midazolam, Etomidate, Propofol, Fentanyl, Ketamine, and Propofol/Ketamine for Procedural Sedation and Analgesia Among Adults in the Emergency Departments: A Systematic Review

Remifentanil for Carboprost-Induced Adverse Reactions During Cesarean Delivery Under Combined Spinal-Epidural Anesthesia

Clinical efficacy of intravenous anesthesia on breast segmental surgery and its effects on oxidative stress response and hemodynamics of patients

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