Severe Cardiovascular Depression with Remifentanil

Elliott, Paul I. P.; O'Hare, R; Bill, K. M.; Phillips, A. S.; Gibson, F. M.; Mirakhur, R. K.

doi:10.1097/00000539-200007000-00011

Cited by 65 publications

(39 citation statements)

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“…Severe bradycardia induced by remifentanil has been reported in numerous studies in adults [2][3][4] and in children [20][21][22]. In the overall analysis of the effects of remifentanil without atropine (REMI group), the lengthening of RR interval and the simultaneous increase of the HF component and rmssd suggested parasympathetic activation in the genesis of this bradycardia.…”

Section: Discussionmentioning

confidence: 90%

“…Opioids can cause arterial hypotension and a moderate bradycardia, which can be counteracted by the administration of atropine. With the use of remifentanil in adults, stronger side effects have been reported, including bradycardia and asystole [2][3][4]. In spite of these observations, which could suggest a different mechanism of pathophysiological action from that of other opioids, few studies have attempted to investigate this phenomenon.…”

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confidence: 99%

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Effect of remifentanil with and without atropine on heart rate variability and RR interval in children

et al. 2005

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SummaryRemifentanil can cause bradycardia either by parasympathetic activation or by other negative chronotropic effects. The high frequency (HF) component of heart rate variability (HRV) is a marker of parasympathetic activity. This study aimed to evaluate the effect of remifentanil on RR interval and on HRV in children. Forty children ASA I or II were studied after approval by the human studies committee and informed parental consent was obtained. After stabilisation at sevoflurane 1 MAC, they were randomly divided into two groups: one received a 20 lg.kg atropine injection (AT + REMI) and the other ringer lactate solution (REMI). Three minutes later, a 1 lg.kg )1 bolus of remifentanil was administered over 1 min, followed by a continual infusion at 0.25 lg.kg )1 .min )1 for 10 min increased to 0.5 lg.kg )1 .min )1 for a further 10 min.A time varying, autoregressive analysis of RR sequences was used to estimate classical spectral parameters: low (0.04-0.15 Hz; LF) and high (0.15-0.45 Hz; HF) frequency, whereas the root mean square of successive differences of RR intervals (rmssd) was derived directly from the temporal sequence. Statistical analyses were conducted by means of the multiple correspondence analysis and with non parametrical tests. Remifentanil induced an RR interval lengthening, i.e. bradycardia, in both groups compared to pretreatment values and was associated with an increase of HF and rmssd only for the REMI group. The parasympathetic inhibition by atropine did not totally prevent remifentanil's negative chronotropic effect. A direct negative chronotropic effect of remifentanil is proposed.

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Section: Discussionmentioning

confidence: 90%

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confidence: 99%

Effect of remifentanil with and without atropine on heart rate variability and RR interval in children

et al. 2005

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“…O remifentanil, assim como outros opióides, pode causar bradicardia e assistolia, antes ou durante a laringoscopia e intubação traqueal [10][11][12][13][14][15][16][17][18][19][20][21] . Inicialmente esse quadro foi atribuído a mecanismo centralmente mediado; entretanto, sabe-se que a morfina apresenta um efeito direto no nódulo sinoatrial e na condução atrioventricular 22,23 .…”

Section: Discussionunclassified

“…Esse perfil farmacocinético e farmacodinâmico é muito atraente, sobretudo para a realização de procedimentos rápidos. Entretanto, o seu uso está associado à instabilidade hemodinâmica, com hipotensão arterial e bradicardia [10][11][12][13][14] . Além disso, há na literatura o relato de dois casos de assistolia após o uso de remifentanil na indução anestésica 15,16 .…”

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Estudo prospectivo das repercussões de baixas doses de remifentanil na função sinoatrial e na condução e refratariedade cardíaca

Leite¹,

Firme²,

Bevilaqua³

et al. 2007

Rev. Bras. Anestesiol.

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), após 5 minutos (M0) avaliou-se o grau de sedação de intensidade de dor, pressões arteriais sistólica e diastólica, freqüências cardíaca e respiratória e saturação de oxigênio. O eletrofisiologista avaliou as variáveis de condução cardíaca (duração do QRS, intervalos AA, AH, HV e PA), o tempo de recuperação do nódulo sinoatrial e as variáveis de refratariedade cardíaca (período refratário do átrio direito, período refratário do ventrículo direito e período refratário do nódulo atrioventricular). Após as medidas iniciais o remifentanil foi introduzido (bolus de 0,5 µg.kg -1 + infusão de 0,05 µg.kg ) e após 20 minutos as mesmas variáveis foram reavaliadas (M1). RESULTADOS: Observou-se diminuição das pressões sistólica e diastólica (p = 0,0001) entre M0 e M1, sem diferença estatística significativa da freqüência respiratória ou da saturação de oxigênio. Houve aumento do intervalo átrio-His (p = 0,006) e do tempo de recuperação do nódulo sinoatrial (p = 0,0004), do período refratário do átrio direito (p = 0,001) e do período refratário do nódulo atrioventricular (p = 0,0001), porém não houve diminuição da freqüência cardíaca basal entre M0 e M1. CONCLUSÕES: O remifentanil alterou as variáveis eletrofisiológi-cas cardíacas, o que em doses maiores que as estudadas poderiam causar bradicardia sinusal, assistolia e distúrbios de condução. Unitermos: ANALGÉSICOS, Opióide: remifentanil, CIRURGIA, Cardíaca: ablação; COMPLICAÇÕES: assistolia, bradicardia; FISIOLO-GIA, Cardiovascular: condução, refratariedade. SUMMARYLeite SS, Firme EBP, Bevilaqua MS, Pereira LS, Atié J -Prospective Study on the Repercussions of Low Doses of Remifentanil on Sinoatrial Function and in Cardiac Conduction and Refractory Period. BACKGROUND AND OBJECTIVES:Remifentanil is an opiod with fast onset of action and short acting, and its use in short-duration procedures has increased in the last few years. Bradycardia and asystole are among the side effects reported. The objective of this study was to evaluate the effects of this drug in cardiac conduction and refractory period in human beings. METHODS: A prospective study with 16 patients, ages 18 to 65, both genders, ASA I to III, undergoing elective intracardiac electrophysiological study, was undertaken. Patients with disorders of the sinoatrial node and those with severe cardiac blocks were excluded. In the laboratory of electrophysiology, patients were sedated with midazolam (0.03 mg.kg -1 ) after 5 minutes the degree of sedation and degree of pain, systolic and diastolic blood pressure, heart rate and respiratory rate, and oxygen saturation were evaluated. The electrophysiologist evaluated cardiac conduction (duration of the QRS complex, and AA, AH, HV, and PA intervals), duration of sinoatrial node recovery, and cardiac refractory period (refractory period of the right atrium, right ventricle, and atrioventricular node). After the initial measurements, remifentanil was administered (bolus of 0.5 µg.kg -1 + infusion of 0.05 µg.kg -1 .min -1 ) and, after 20 minutes, the same parameters were eval...

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“…..................................................................................................................................................................................................................... Several authors have reported hypotension and bradycardia after remifentanil administration [7][8][9], particularly when given as a bolus [10]. DeSouza et al [10] reported heart rates of < 30 beat.min )1 and systolic blood pressures < 80 mmHg in six of eight patients undergoing cardiothoracic procedures who were given a bolus dose of remifentanil 1 lg.kg )1 .…”

Section: Discussionmentioning

confidence: 99%

The use of remifentanil in the anaesthetic management of patients undergoing adrenalectomy: A report of three cases

Breslin¹,

Farling

Mirakhur

2003

Anaesthesia

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SummaryThe use of remifentanil has been recommended because of its ability to minimise the hypertensive response to tracheal intubation and surgical stimulation in various types of surgery. We describe the use of remifentanil in the anaesthetic management of three cases of open adrenalectomy, two for removal of a phaeochromocytoma and one for removal of an adrenal cortical tumour. Although the use of remifentanil was associated with no adverse events in the patient undergoing resection of the adrenal cortical tumour, its administration was associated with significant hypotension and bradycardia in the two phaeochromocytoma patients, who had both been given a-and b-adrenergic receptor blocking drugs before surgery. It did not prevent the increases in blood pressure or plasma catecholamine levels associated with tumour manipulation in these patients. Remifentanil should therefore be used with caution in patients receiving a-and b-adrenergic receptor blocking drugs. The use of potent vasodilators may still be necessary during tumour manipulation even if remifentanil is being infused.

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Severe Cardiovascular Depression with Remifentanil

Cited by 65 publications

References 6 publications

Effect of remifentanil with and without atropine on heart rate variability and RR interval in children

Effect of remifentanil with and without atropine on heart rate variability and RR interval in children

Estudo prospectivo das repercussões de baixas doses de remifentanil na função sinoatrial e na condução e refratariedade cardíaca

The use of remifentanil in the anaesthetic management of patients undergoing adrenalectomy: A report of three cases

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