A low-dose remifentanil infusion is well tolerated for sedation in mechanically ventilated, critically-ill patients

Abstract

P Pu ur rp po os se e: : To study the analgesic and sedative effects of remifentanil in critically-ill patients.M Me et th ho od ds s: : Remifentanil infusion was started at 0.02 µg·kg -1 ·min -1 in ten mechanically ventilated critically-ill patients, and the infusion rate was increased to 0.05, 0.10, 0.15, 0.20, and 0.25 µg·kg -1 ·min -1 every 30 min. Basally and 25 min after each increase we measured: the Ramsey sedation score (RSS) and the respiratory response subscore of comfort scale (CSRR); the bispectral index (BIS) before and after lightly touching tracheal mucosa; heart rate and systemic arterial pressure; respiratory variables; plasma epinephrine and norepinephrine levels.R Re es su ul lt ts s: : Infusion rates up to 0.05 µg·kg -1 ·min -1 were effective against agitation and achieved a good degree of adaption to the respirator in all patients (RSS 2 or more and CSRR 3 or less); BIS decreased significantly; respiratory and circulatory variables were unaffected; mean plasma epinephrine levels decreased. At infusion rates higher than 0.05 µg·kg -1 ·min -1 RSS but not BIS decreased further and patient arousability caused by noxious stimuli was not prevented; respiratory drive suppression occurred at the infusion rates higher than 0.05 µg·kg -1 ·min -1 in four patients; bradycardia and arterial hypotension was observed in three patients; plasma epinephrine levels decreased significantly, while norepinephrine was unaffected; severe itching was experienced by one patient.C Co on nc cl lu us si io on ns s: : Low doses of remifentanil (up to 0.05 µg·kg -1 ·min -1 ) can be useful in critically-ill patients in order to achieve calm and sedation. Higher doses can inhibit respiratory drive and require controlled mechanical ventilation. Objectif

Comparison of an Intraoperative Infusion of Dexmedetomidine or Remifentanil on Perioperative Haemodynamics, Hypnosis and Sedation, and Postoperative Pain Control

“…to obtain calmness or loss of consciousness, to decrease sympathetic tone or even to inhibit respiratory rate. 30 This is characteristic of dexmedetomidine, which does not induce respiratory depression, 3 and can therefore be utilized in regional anaesthesia, intubation and extubation during arousal. A BIS value of 0 equals electroencephalographic (EEG) silence, while near 100 is the expected value in a fully awake adult, and between 40 and 60 indicates a level for general anaesthesia.…”

Dexmedetomidine Versus Midazolam for the Sedation of Patients with Non-invasive Ventilation Failure

“…Recently, studies using various sedative drug (remifentanil, propofol, midazolam) in patients who became agitated during NIV demonstrated their efficacy for sedation (15)(16)(17). Midazolam was selected as the medication for comparison in our study owing to its frequent use for long-term sedation, and it was administered as a continuous infusion owing to its short half-life (18).…”

Sedation during noninvasive mechanical ventilation

“…Uzun süre-li infüzyonu ilacın birikmesine ve hastanın uyanmasında gecikmeye sebep olabilir (25). Cavaliere ve arkadaşları benzer sonuçları düşük doz remifentanil infüzyonu ile bildirmişlerdir (26). Remifentanil yeni geliştirilmiş anilidopiperidin grubu bir opioiddir.…”