The use of remifentanil in critically ill patients undergoing percutaneous dilatational tracheostomy: A prospective randomized‐controlled trial

Abstract

Remifentanil was a μ‐agonist, with a rapid onset, a powerful narcotic analgesic activity and a fast nonspecific esterases hydrolyzation and theoretically an ideal opioid for percutaneous dilatational tracheostomy (PDT). The present study discussed use of remifentanil in critically ill patients undergoing PDT. Ninety‐nine patients were randomly assigned to the propofol/remifentanil group (PR group, n = 49) or the propofol group (P group, n = 50). Two patients (one in P group and one in PR group) were excluded and transferred to surgical way of tracheostomy because of uncontrolled bleeding. The primary outcomes were critical care pain observation (CPOT) scores during PDT; hemodynamic response and side effects, such as bleeding and muscle rigidity (MR). CPOT scores in P group were significantly higher than in PR group during incision and dilation stages (P < 0.05 and P < 0.01). Systolic blood pressure had a significant drop after a bolus of remifentanil in PR group compared with patients in P group (P < 0.056). The incidence of MR was significantly higher in PR group than in P group (P < 0.05). Recovery time in PR group was significantly shorter than in P group (P < 0.05). The occurrence of tachycardia, bleeding, vomiting, and nausea had no statistically differences in both groups. Patients in PR group were undergoing shorter recovery time and better experience of pain in PDT compared with patients in P group, but MR seemed to be higher in PR group. Remifentanil seemed to be a safe and effective opioid used in critically ill patients undergoing PDT.

Postoperative pain after different doses of remifentanil infusion during anaesthesia: a meta-analysis

“…ketorolac ①③④⑥⑧⑨⑩ Kim2018 [ 34 ] gastrectomy 39/40 12 ng/ml vs 2 ng/ml Sevoflurane PCIA: fentanyl ①②⑦⑧⑨ Kim2018 [ 34 ] gastrectomy 39/38 12 ng/ml vs placebo Sevoflurane PCIA: fentanyl ①②⑦⑧⑨ Park2018 [ 36 ] lower extremity surgery 46/46 0.25 μg/kg/min vs 0.05 μg/kg/min Sevoflurane i.v. pethidine, et al ①⑥⑦⑨⑩ Chang2019 [ 31 ] tracheostomy 49/48 0.1 μg/kg/min vs placebo Propofol Not specified ①⑨ Khidr2020 [ 33 ] cardiac surgery 23/25 3 ng/ml vs 1 ng/ml Sevoflurane +propofol PCIA: morphine ⑦⑧ Su2020 [ 38 ] laparoscopic cholecystectomy 60/60 0.3 μg/kg/min vs 0.1 μg/kg/min Sevoflurane PCIA: sufentanil ①⑤⑦⑧⑨⑩ ①Pain score at rest ②Pain score at movement ③Periincisional mechanical pain threshold ④Forearm mechanical pain threshold ⑤Time to first postoperative analgesic requirement ⑥Need for rescue analgesic ⑦Analgesic consumption ⑧Emergence time ⑨PONV ⑩Shivering …”

“…22 trials compared high dose group with low-dose groups [ 5 – 8 , 15 , 17 , 19 – 22 , 28 , 29 , 32 – 36 , 38 – 41 ]. 12 trials compared remifentanil with remifentanil-free groups [ 5 , 16 , 18 , 23 – 27 , 30 , 31 , 34 , 37 ].…”