Remifentanil vs fentanyl/morphine for pain and stress control during pediatric cardiac surgery

Bell, Graham; Dickson, U.; Arana, A.; Robinson, Dror; Marshall, Caroline; Morton, Neil S.

doi:10.1111/j.1460-9592.2004.01326.x

Cited by 17 publications

(8 citation statements)

References 8 publications

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“…Consequently, the use of NMDA antagonists, such as ketamine, has been hypothesized to counteract sensitization and produce an analgesic‐sparing effect. Intravenous ketamine has been found to produce both analgesic and anti‐sensitization effects in adult patients (8,9). However, its efficacy in children is still controversial.…”

Section: Introductionmentioning

confidence: 99%

Ketamine for perioperative pain management in children: a meta‐analysis of published studies

Dahmani

Michelet

Abback

et al. 2011

Pediatric Anesthesia

140

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Summary Introduction: Balanced analgesia, using both opioid and nonopioids agents, has become the standard care for postoperative pain management. Ketamine, a compound with analgesic and antihyperalgesic properties, has been shown to decrease postoperative pain and opioid requirements in adults. The goal of the present meta‐analysis was to investigate postoperative analgesic properties of ketamine in pediatric patients. Material and methods: A comprehensive literature search was conducted to identify clinical trials that used ketamine as a perioperative analgesic compound in children and infants. Outcomes measured were postoperative analgesic consumption, pain intensity and duration of sensory block (when ketamine was used by caudal route) during the postoperative care unit (PACU) stay and the early postoperative period (6–24 h after leaving the operative room). The data from each trial were combined to calculate the pooled odds ratios or standard mean differences and their 95% confidence intervals. Results: Thirty‐five randomized, blinded controlled studies were retrieved from the literature. Systemic ketamine was effective in decreasing PACU pain intensity and analgesic requirement but failed to influence early (6–24 h) pain intensity and analgesic requirement. Ketamine administered locally during tonsillectomy, decreased PACU and early (6–24 h) pain intensity and PACU analgesic requirements. Used as an adjuvant for caudal analgesia, ketamine increased the duration of sensory block and PACU analgesic requirement without impacting PACU pain intensity. Ketamine failed to exhibit a postoperative opioid‐sparing effect. Conclusions: This meta‐analysis found that administration of ketamine was associated with decreased PACU postoperative pain intensity and nonopioid analgesic requirement. However, ketamine failed to exhibit a postoperative opioid‐sparing effect.

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Section: Introductionmentioning

confidence: 99%

Ketamine for perioperative pain management in children: a meta‐analysis of published studies

Dahmani

Michelet

Abback

et al. 2011

Pediatric Anesthesia

140

View full text Add to dashboard Cite

show abstract

“…G Bell et al compared remifentanil, morphine and fentanyl for pain and stress control by estimating the sugar and cortisol level, and found cortisol and glucose level were very low in morphine and fentanyl group than remifentanil. 9 In India remifentanil is not widely available. So we have taken fentanyl and morphine for comparison.…”

Section: Discussionmentioning

confidence: 99%

Comparison of morphine and fentanyl in attenuation of Intra operative stress response under general anesthesia: A randomized double blinded study

Prabu

Rani

2014

Asian J Med Sci

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Background: This randomized double blinded study was done to compare the effect of intravenous morphine and fentanyl in attenuation of stress response during surgeries under general anesthesia in adults. The attenuation of stress response was analyzed with changes in serum cortisol and glucose levels one hour after induction of anesthesia. Methods: Fifty consented healthy volunteers in age group 20-50, under ASA I and ASA II posted for elective surgery were included in the study. Two groups of 25 each, group M who received 0.2 mg/kg body weight of morphine and group F who received 2 microgram/kg body weight of fentanyl before anaesthetic induction were compared. The members of two groups were randomly allocated and double blinded using sealed envelope technique. Blood samples were collected for baseline glucose and cortisol in all the subjects. One hour after the administration of study drugs, which was given at the time of induction blood samples were collected for analysis of glucose and cortisol. The changes in blood glucose and serum cortisol levels were compared at the end of the study using independent samples 't' test. Results: There was no significant difference in blood sugar levels in both groups at the end of 1 hour. But there was significant increase in serum cortisol levels in group F compared to group M. Conclusion: This study concludes that morphine is better than fentanyl in attenuation of Intraoperative stress by effectively controlling serum cortisol levels. This study was conducted to compare the effect of intravenous fentanyl and intravenous morphine in attenuation of stress response in adult patients who underwent surgery under general anesthesia. The attenuation of stress response was analyzed based on changes in serum cortisol levels and blood glucose levels in both the groups by comparing baseline values and post anesthetic induction values. The selected patients were randomly divided into two groups, group M and group F. Randomization and blinding was done using sealed envelope technique. All the Patients were premedicated with tablet diazepam 10 mg the night before surgery. Group M received morphine 0.2 mg per kg body weight and Group F received fentanyl 2 mcg per kg body weight just before induction. MATERIALS AND METHODSIn the operating room, after securing an intra venous line blood sample was taken for glucose and cortisol analysis (sample 1). The standard monitoring was established with continuous ECG monitoring, automated non-invasive blood pressure, pulseoximeter and post intubation endtidal carbon dioxide. Patients received intravenous (IV) midazolam 1 mg and study drug, either morphine or fentanyl (as labeled in sealed envelope) which was loaded in 5 ml syringe. After pre oxygenation patients were induced with thiopentone sodium 5 mg/kg body weight. Succinylcholine 2 mg/kg body weight was given to facilitate endo-tracheal intubation. Anesthesia was maintained with oxygen, nitrous oxide, isoflurane and vecuronium. Hemodynamics and arterial oxygen saturation were recorded at 3 mi...

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“…A pesar de las anormalidades en la conducción neuromuscular, la respuesta a agentes bloqueadores neuromusculares es normal. El uso de opioides puede reducir la tasa de hiperglucemia, pero el efecto analgésico de la morfina disminuye en diabéticos, por lo cual se pueden requerir dosis mayores 46,47 . La elección del anestésico en la práctica continúa siendo tema de estudio.…”

Section: Peroodo Intraoperatoriounclassified

Factores fisiopatológicos y metas terapéuticas perioperatorias que influyen en procedimientos quirúrgicos reconstructivos mediante colgajos en pacientes con Diabetes Mellitus

Alvear

et al. 2017

revmed

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Artículo recibido el 12 de Junio de 2016 y aceptado para publicación el 16 de Noviembre de 2016 RESUMEN Introducción: la diabetes mellitus es considerada un factor de riesgo para complicaciones locales y fracaso quirúrgico en cirugías reconstructivas mediante el uso de colgajos debido a las alteraciones en el proceso de cicatrización propias de este patología. Objetivo: hacer una revisión de la literatura disponible sobre los factores fisiopatológicos que influyen en los resultados posquirúrgicos a corto, mediano y largo plazo en la población diabética, así como de las metas terapéuticas perioperatorias asociadas a mayores tasas de éxito. Metodología de Búsqueda: se realizó búsqueda en las bases de datos PUBMED, MEDLINE Y SCIELO, mediante el gestor de búsqueda utilizando los términos: "Period perioperative", "Reconstructive surgical procedures", "Surgical flaps", "Diabetes mellitus", obteniendo un total de 160 artículos de revistas en línea, de los cuales se seleccionaron 50. Resultados: la realización de colgajos en pacientes con diabetes mellitus se asocia a mayor riesgo de fracaso y complicaciones, las cuales disminuyen considerablemente si se realiza un estricto manejo perioperatorio enfocado en metas. Conclusiones: la diabetes mellitus causa alteraciones en la respuesta inflamatoria, disfunción microvascular y mayor estrés oxidativo, lo cual se ve reflejado en un proceso de cicatrizacion anormal, generando mayores tasas de infeccion y perdidas de colgajos; un estricto manejo peri operatorio guiado por metas logra disminuir las complicaciones y aumentar el exito quirurgico. Pathophysiologic factors and perioperative therapeutic goals that affect reconstructive surgical procedures with flaps in patients with Diabetes MellitusABSTRACT Introduction: diabetes mellitus is considered a risk factor for local complications and surgical failure in reconstructive surgeries, mainly in flaps due to the fact that it causes alterations in the cicatrization process. Objective: to review the available literature on the pathophysiological factors that influence the short-, medium-and long-term results in the diabetic population, the perioperative therapeutic goals associated with higher success rates, and to establish a baseline protocol for the perioperative management of these patients. Searching methodology: we searched the PUBMED, MEDLINE and SCIELO databases using the search terms "Period

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Remifentanil vs fentanyl/morphine for pain and stress control during pediatric cardiac surgery

Cited by 17 publications

References 8 publications

Ketamine for perioperative pain management in children: a meta‐analysis of published studies

Ketamine for perioperative pain management in children: a meta‐analysis of published studies

Comparison of morphine and fentanyl in attenuation of Intra operative stress response under general anesthesia: A randomized double blinded study

Factores fisiopatológicos y metas terapéuticas perioperatorias que influyen en procedimientos quirúrgicos reconstructivos mediante colgajos en pacientes con Diabetes Mellitus

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