Severe Cardiovascular Depression with Remifentanil

Can intravenous atropine prevent bradycardia and hypotension during induction of total intravenous anesthesia with propofol and remifentanil?

“…The hemodynamic instability caused by this anesthetic regimen could be critical [1]. These adverse effects are at least partly the result of the centrally mediated vagotonic and/or sympatholytic action of remifentanil [2,3] and the centrally mediated sympatholytic action of propofol [4].…”

Remifentanil plus low-dose midazolam for outpatient sedation in transesophageal echocardiography

“…Moreover, the ultra-short action and rapid elimination of remifentanil made us confident that, should a drug-induced side-effect occur, we would be able to treat it quickly by simply stopping the IV infusion. No such event occurred; however, remifentanil is known to have been associated with severe episodes of cardiovascular instability, particularly in the elderly, although at much higher doses than the one we used in this study [19,20]. Therefore we feel that the drug regimen administered to patients in both groups has the potential for significant cardio-respiratory depression and we would like to study a much larger number of patients before reaching conclusions about the safety profile of our novel sedation protocol for TEE.…”

Extubation time, hemodynamic stability, and postoperative pain control in patients undergoing coronary artery bypass surgery: an evaluation of fentanyl, remifentanil, and nonsteroidal antiinflammatory drugs with propofol for perioperative and postoperative management

“…Intravenous remifentanil use in cardiac surgical patients was associated with frequent occurrence of hypotension, with little benefit in terms of earlier tracheal extubation when compared with IV fentanyl [6]. A study in which remifentanil was administered as a bolus in patients scheduled for CABG was terminated because of severe bradycardia, hypotension, and a reduction in systemic vascular resistance [10].…”