An Intraoperative Small Dose of Ketamine Prevents Remifentanil-Induced Postanesthetic Shivering

Nakasuji, Masato; Nakamura, Mai; Imanaka, Norie; Tanaka, Masuji; Nomura, Masataka; Suh, Soon Hak

doi:10.1213/ane.0b013e318224ac4e

“…Specific pro‐nociceptive processes are activated by opioid administration, such as engaging N‐methyl‐D‐aspartate (NMDA) receptors, which counteract the analgesic effects . Remifentanil may stimulate the NMDA receptors, and μ ‐opioid receptors, δ‐opioid receptors of remifentanil or glycine (an additive in remifentanil preparations) could directly stimulate NMDA receptors . It has also been noted that the magnitude of tolerance is unrelated to opioid potency .…”

Section: Cellular Mechanisms Of Acute Opioid Tolerance and Opioid‐indmentioning

confidence: 99%

Remifentanil tolerance and hyperalgesia: short‐term gain, long‐term pain?

Yu

¹

,

Tran

²

,

Lam

³

et al. 2016

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SummaryThe unique pharmacology of remifentanil makes it a popular intra-operative analgesic. Short-acting opioids like remifentanil have been associated with acute opioid tolerance and/or opioid-induced hyperalgesia, two phenomena which have different mechanisms and are pharmacologically distinct. Clinical studies show heterogeneity of remifentanil infusion regimens, durations of infusion, maintenance of anaesthesia, cumulative dose of remifentanil and pain measures, which makes it difficult to draw conclusions about the incidence of acute tolerance or hyperalgesia. However, it appears that intra-operative remifentanil infusion rates of above 0.25 lg.kg À1.min À1 are associated with higher postoperative opioid consumption, suggesting tolerance. Infusion rates greater than 0.2 lg.kg À1.min À1 are characterised by lower mechanical/pressure/cold/pain thresholds, which suggests hyperalgesia. The use of concurrent multimodal analgesia, especially N-methyl-D-aspartate receptor antagonists, may be an effective preventive strategy.The clinical significance and long-term consequences of these entities is still uncertain.

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“…Nakasuji et al showed a decrease in SVR, not CO, is the main mechanism of hypotension seen during SA in elderly patients [17]. Marhofer and co-workers [18] also showed that SAIH in elderly ASA 3…”

Section: Discussionmentioning

confidence: 97%

The Influence Of The Infusion Of Ephedrine And Phenylephrine On The Hemodynamic Stability After Subarachnoid Anesthesia In Senior Adults - A Controlled Randomized Trial

Žunić

¹

,

Škvarč

²

,

Kamenik

³

2019

Preprint

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Study objective: We studied the influence of ephedrine or phenylephrine infusion given immediately after spinal anesthesia (SA) on hemodynamics in elderly orthopedic patients. Design: A prospective, randomized, double-blind, placebo-controlled study. Intervention: After subarachnoid injection of 15 mg of levobupivacaine the participants received either an infusion of ephedrine 20 mg (E group), phenylephrine 250 mcg (P group) or saline (C group) within 30 minutes. For 15 minutes before and and 30 minutes after SA we measured blood pressure, cardiac index (CI) and heart rate (HR). Results 70 patients were included in the final analysis. At the end of measurements mean arterial pressure decreased significantly after SA in comparison to baseline in the C group but was maintained in the P and the E group, with no significant differences between the groups. CI decreased after SA in the C group was maintained in the P group and increased significantly in the E group, with significant differences between the C and the E group (p=0.049) and between the P and the E (p=0.01) group at the end of measurements. HR decreased significantly after SA in the C and the P group and was maintained in the E group, with significant differences between the P and the E group (p=0.033) at the end of measurements. Conclusions Hemodynamic changes after SA in elderly orthopedic patients can be prevented by an immediate infusion of phenylephrine or ephedrine. In addition to maintaining blood pressure the ephedrine infusion also maintains HR and increases CI after spinal anaesthesia. Key words: spinal anesthesia, hemodynamic stability, phenylephrine, ephedrine Trial registration: ISRCTN registry ISRCTN44377602. Registered on 15 June 2017.

show abstract

“…Nakasuji et al showed a decrease in SVR, not CO, is the main mechanism of hypotension seen during SA in elderly patients [13]. Marhofer and co-workers [14] also showed that SAIH in elderly ASA 3…”

Section: Discussionmentioning

confidence: 97%

The Influence Of The Infusion Of Ephedrine And Phenylephrine On The Hemodynamic Stability After Subarachnoid Anesthesia In Senior Adults - A Contolled Randomized Trial

Žunić

¹

,

Škvarč

²

,

Kamenik

³

2019

Preprint

0

View full text Add to dashboard Cite

Study objective: We studied the influence of ephedrine or phenylephrine infusion given immediately after spinal anesthesia (SA) on hemodynamics in elderly orthopedic patients. Design: A prospective, randomized, double-blind, placebo-controlled study. Intervention: After subarachnoid injection of 15 mg of levobupivacaine the participants received either an infusion of ephedrine 20 mg (E group), phenylephrine 250 mcg (P group) or saline (C group) within 30 minutes. For 15 minutes before and and 30 minutes after SA we measured blood pressure, cardiac index (CI) and heart rate (HR). Results 70 patients were included in the final analysis. At the end of measurements mean arterial pressure decreased significantly after SA in comparison to baseline in the C group but was maintained in the P and the E group, with no significant differences between the groups. CI decreased after SA in the C group was maintained in the P group and increased significantly in the E group, with significant differences between the C and the E group (p=0.049) and between the P and the E (p=0.01) group at the end of measurements. HR decreased significantly after SA in the C and the P group and was maintained in the E group, with significant differences between the P and the E group (p=0.033) at the end of measurements. Conclusions Hemodynamic changes after SA in elderly orthopedic patients can be prevented by an immediate infusion of phenylephrine or ephedrine. In addition to maintaining blood pressure the ephedrine infusion also maintains HR and increases CI after spinal anaesthesia. Key words: spinal anesthesia, hemodynamic stability, phenylephrine, ephedrine Trial registration: ISRCTN registry ISRCTN44377602. Registered on 15 June 2017.

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An Intraoperative Small Dose of Ketamine Prevents Remifentanil-Induced Postanesthetic Shivering

Cited by 15 publications

References 14 publications

Remifentanil tolerance and hyperalgesia: short‐term gain, long‐term pain?

Remifentanil tolerance and hyperalgesia: short‐term gain, long‐term pain?

The Influence Of The Infusion Of Ephedrine And Phenylephrine On The Hemodynamic Stability After Subarachnoid Anesthesia In Senior Adults - A Controlled Randomized Trial

The Influence Of The Infusion Of Ephedrine And Phenylephrine On The Hemodynamic Stability After Subarachnoid Anesthesia In Senior Adults - A Contolled Randomized Trial

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