The analgesic effect in humans of subanaesthetic isoflurane concentrations evaluated by experimentally induced pain

Petersen-Felix, Steen; Arendt‐Nielsen, Lars; Bak, Peter; Fischer, Michael J.M.; Roth, D.; Bjerring, Peter; Zbinden, A. M.

doi:10.1097/00003643-199607000-00029

Cited by 20 publications

(24 citation statements)

References 37 publications

(41 reference statements)

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“…however, it is generally accepted that subanesthetic concentrations of inhalation anesthetics have no hypoalgesic or hyperalgesic effects. [27][28][29] It is thus unlikely that residual sevoflurane confounded our results. Further studies are needed to investigate the relationship between inhaled anesthesia and the development of acute opioid tolerance.…”

Section: Discussionmentioning

confidence: 91%

Intraoperative Infusion of 0.6–0.9 µg · kg−1 · min−1 Remifentanil Induces Acute Tolerance in Young Children after Laparoscopic Ureteroneocystostomy

et al. 2013

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Background: Intraoperative infusion of opioids has been associated with increased postoperative pain and analgesic requirements, but the development of tolerance in young children is less clear. This prospective, randomized, doubleblinded study was designed to test the hypothesis that the intraoperative administration of remifentanil results in postoperative opioid tolerance in a dose-related manner in young children. Methods: We enrolled 60 children (aged 1-5 yr) who were undergoing elective laparoscopic ureteroneocystostomy. Patients were randomized and received an intraoperative infusion of 0, 0.3, 0.6, or 0.9 µg·kg −1 ·min −1 remifentanil. Postoperative pain was managed by a parent/nurse-controlled analgesia pump using fentanyl. The primary outcome included the total fentanyl consumptions at 24 and 48 h postsurgery. Secondary outcomes were the postoperative pain scores and adverse effects. Results:The children who received 0.6 and 0.9 µg·kg −1 ·min −1 remifentanil required more postoperative fentanyl than the children who received saline or 0.3 µg·kg −1 ·min −1 remifentanil (all P < 0.001) for 24 h after surgery. The children who received 0.3-0.9 µg·kg −1 ·min −1 intraoperative remifentanil reported higher pain scores at 1 h after surgery than the children who received saline (P = 0.002, P = 0.023, and P = 0.006, respectively). No significant intergroup differences in recovery variables were observed, but vomiting was more frequent in the 0.9 µg·kg ·min−1 remifentanil to young children resulted in acute tolerance for 24 h after surgery in an apparently dose-related manner.T he unique pharmacodynamic and pharmacokinetic characteristics of remifentanil have increased its dominant intraoperative role in children.1,2 The context-sensitive halftime of remifentanil renders the offset for effect dose-independent, thus allowing prolonged infusion of large doses with little risk for delayed awakening or respiratory depression after surgery. 3,4 Similar to other potent opioids, however, intraoperative remifentanil may induce hyperalgesia and tolerance, manifesting as increased postoperative pain and analgesic requirements. [5][6][7] Opioid-induced hyperalgesia is a paradoxical pain sensitization of the nervous system whereby a patient receiving an opioid for the treatment of pain might actually have an increase in pain perception to noxious stimuli. 8 Tolerance is a pharmacologic concept defined as a progressive decrease in response to a drug and which can be overcome by increasing the dose of the drug. Although the difference between hyperalgesia and tolerance is difficult to tease out, opioid-induced hyperalgesia and tolerance may complicate the perioperative course of a patient who receives intraoperative opioid.In young children, however, only a few studies have investigated the development of tolerance after the intraoperative infusion of remifentanil, and the results were anecdotal and Intraoperative Infusion of 0.6-0.9 µg · kg

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Section: Discussionmentioning

confidence: 91%

Intraoperative Infusion of 0.6–0.9 µg · kg−1 · min−1 Remifentanil Induces Acute Tolerance in Young Children after Laparoscopic Ureteroneocystostomy

et al. 2013

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“…In a recent study we found no analgesic effect of subanaesthetic concentrations of isoflurane on experimental pain tests [6]. These pain tests may, however, not always be able to detect a weak analgesic effect [7].…”

mentioning

confidence: 76%

“…The subanaesthetic concentrations of isoflurane were delivered via a face mask. The breathing system and the gas monitors have been described previously [6].…”

Section: Methodsmentioning

confidence: 99%

Analgesic effect in humans of subanaesthetic isoflurane concentrations evaluated by evoked potentials

Roth

Petersen-Felix

Bak

et al. 1996

British Journal of Anaesthesia

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SummaryThe aim of this study was to see if an analgesic effect of subanaesthetic concentrations of isoflurane could be detected with evoked potentials elicited by nociceptive stimuli. We studied 10 healthy volunteers breathing three steady-state subanaesthetic concentrations of isoflurane (0.08, 0.16 and 0.24 vol% end-tidal). Reaction time, subjective pain intensities and evoked vertex potentials to laser (LEP) and electrical (SEP) stimuli were recorded and compared with auditory evoked potentials (AEP). Compared with baseline, the subanaesthetic concentrations of isoflurane did not change the latencies of the evoked potentials, but caused a significant reduction in the amplitudes of the LEP and SEP at 0.16 and 0.24 vol% and of the AEP at all three concentrations. There were no changes in perceived pain intensity, and isoflurane produced similar reductions in evoked potentials elicited by both nociceptive and non-nociceptive stimuli. The reaction time was increased significantly at 0.24 vol% isoflurane. The results demonstated that subanaesthetic isoflurane concentrations caused similar changes in evoked potentials with both painful and non-painful stimuli, with no effect on perceived pain intensity. (Br.

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“…Existen varios experimentos en los que voluntarios sanos inhalaron dosis subanestésicas de diversos anestésicos halogenados durante breves periodos de tiempo y fueron sometidos a diversos estímulos dolorosos cutáneos (17,18). En ninguno de estos trabajos se encontró que los fármacos estudiados produjesen un efecto analgésico significativo.…”

Section: Experiencias Preclínicas Empleando Derivados Halogenados Delunclassified

Eficacia analgésica del sevoflurano tópico en heridas

Pardo

Sáenz

2017

Rev. Soc. Esp. Dolor.

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Instrucciones de citación para el artículo / Citation instructions for the article:Gerónimo Pardo Manuel, Cortiñas Sáenz Manuel. Eficacia analgésica del sevoflurano tópico en heridas / Analgesic efficacy of topical sevoflurane on wounds. Rev. Soc. Esp. Dolor. 2017Dolor. . doi: 10.20986/resed.2017Dolor. .3617/2017 Este es un archivo PDF de un manuscrito inédito que ha sido aceptado para su publicación en la Revista de la Sociedad Española del Dolor. Como un servicio a nuestros clientes estamos proporcionando esta primera versión del manuscrito en estado de prepublicación. El manuscrito será sometido a la corrección de estilo final, composición y revisión de la prueba resultante antes de que se publique en su forma final. Tenga en cuenta que durante el proceso de producción se pueden dar errores lo que podría afectar el contenido final. El copyright y todos los derechos legales que se aplican al artículo pertenecen a la Revista de la Sociedad Española de Dolor.

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The analgesic effect in humans of subanaesthetic isoflurane concentrations evaluated by experimentally induced pain

Cited by 20 publications

References 37 publications

Intraoperative Infusion of 0.6–0.9 µg · kg−1 · min−1 Remifentanil Induces Acute Tolerance in Young Children after Laparoscopic Ureteroneocystostomy

Intraoperative Infusion of 0.6–0.9 µg · kg−1 · min−1 Remifentanil Induces Acute Tolerance in Young Children after Laparoscopic Ureteroneocystostomy

Analgesic effect in humans of subanaesthetic isoflurane concentrations evaluated by evoked potentials

Eficacia analgésica del sevoflurano tópico en heridas

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