Influence of intraoperative opioid on postoperative pain and pulmonary function after laparoscopic gastric banding: remifentanil TCI vs sufentanil TCI in morbid obesity

Baerdemaeker, L.E.C. De; Jacobs, Stefan; Pattyn, Piet; Mortier, Éric; Struys, Michel

doi:10.1093/bja/aem164

Cited by 31 publications

(10 citation statements)

References 24 publications

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“…We also did not compare the requirement for postoperative analgesia/ opioids, because Gunaydin and colleagues 28 showed that FVC and FEV1 did not change, not even for constant opioid administration in alert patients. This is also confirmed by results reported by others, 29 who found no difference in postoperative lung function after desflurane/remifentanil anaesthesia or desflurane/sufentanil anaesthesia, provided that spirometry was performed at a similar VAS score after administration of various morphine doses.…”

Section: Discussionsupporting

confidence: 90%

Lung function after total intravenous anaesthesia or balanced anaesthesia with sevoflurane

Tiefenthaler

Pehboeck

Hammerle

et al. 2011

British Journal of Anaesthesia

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Section: Discussionsupporting

confidence: 90%

Lung function after total intravenous anaesthesia or balanced anaesthesia with sevoflurane

Tiefenthaler

Pehboeck

Hammerle

et al. 2011

British Journal of Anaesthesia

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“…These adverse effects may be mitigated by avoiding or minimizing opioid dosages or by utilizing a rapidly metabolized opioid such as remifentanil. 6 Continuous infusion of subhypnotic doses of propofol has been used successfully to prevent and treat PONV. 7,8 Infusion of propofol in combination with remifentanil has been demonstrated to decrease the incidence of PONV in comparison to an infusion of remifentanil alone.…”

mentioning

confidence: 99%

Comparison of Propofol-Remifentanil Versus Propofol-Ketamine Deep Sedation for Third Molar Surgery

Kramer

Ganzberg

Prior

et al. 2012

Anesthesia Progress

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This study aimed to compare continuous intravenous infusion combinations of propofol-remifentanil and propofol-ketamine for deep sedation for surgical extraction of all 4 third molars. In a prospective, randomized, double-blinded controlled study, participants received 1 of 2 sedative combinations for deep sedation for the surgery. Both groups initially received midazolam 0.03 mg/kg for baseline sedation. The control group then received a combination of propofol-remifentanil in a ratio of 10 mg propofol to 5 μg of remifentanil per milliliter, and the experimental group received a combination of propofol-ketamine in a ratio of 10 mg of propofol to 2.5 mg of ketamine per milliliter; both were given at an initial propofol infusion rate of 100 μg/kg/min. Each group received an induction loading bolus of 500 μg/kg of the assigned propofol combination along with the appropriate continuous infusion combination . Measured outcomes included emergence and recovery times, various sedation parameters, hemodynamic and respiratory stability, patient and surgeon satisfaction, postoperative course, and associated drug costs. Thirty-seven participants were enrolled in the study. Both groups demonstrated similar sedation parameters and hemodynamic and respiratory stability; however, the ketamine group had prolonged emergence (13.6 ± 6.6 versus 7.1 ± 3.7 minutes, P = .0009) and recovery (42.9 ± 18.7 versus 24.7 ± 7.6 minutes, P = .0004) times. The prolonged recovery profile of continuously infused propofol-ketamine may limit its effectiveness as an alternative to propofol-remifentanil for deep sedation for third molar extraction and perhaps other short oral surgical procedures, especially in the ambulatory dental setting.

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“…[50] Similarly, De Baerdemaeker and colleagues showed that remifentanil offered no significant advantages in recovery profile compared to sufentanil in obese subjects undergoing laparoscopic gastric banding. [51] In addition, the subjects given remifentanil had higher opioid consumption in the immediate postoperative period. Despite remifentanil’s forgiving termination of effect, its use may be questioned as an adjunct to general anesthesia in obese subjects undergoing bariatric surgery.…”

Section: Opioidsmentioning

confidence: 99%

Anesthetic Pharmacology and the Morbidly Obese Patient

Ingrande

Lemmens

2012

Curr Anesthesiol Rep

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Anesthesiologists are increasingly being faced with treating obese patients. Physiologic and anthropometric associated with obesity—most notably increases in cardiac output, changes in tissue perfusion and increases in total body weight (TBW), lean body weight (LBW), and fat mass affect the pharmacokinetics (PK) of anesthetic agents. In addition, redundancy of airway tissue, obstructive and central sleep apnea and CO2 retention affect the pharmacodynamics (PD) of anesthetics and narrow the therapeutic window of numerous anesthetic drugs. Safe and effective pharmacologic management of the obese patient requires a thorough understanding of how obesity affects the PK and PD of anesthetics.

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Influence of intraoperative opioid on postoperative pain and pulmonary function after laparoscopic gastric banding: remifentanil TCI vs sufentanil TCI in morbid obesity

Abstract: As few differences occurred in the postoperative period, the theoretical advantage of remifentanil over the longer acting sufentanil can be questioned when using TCI technology.

Cited by 31 publications

References 24 publications

Lung function after total intravenous anaesthesia or balanced anaesthesia with sevoflurane

Lung function after total intravenous anaesthesia or balanced anaesthesia with sevoflurane

Comparison of Propofol-Remifentanil Versus Propofol-Ketamine Deep Sedation for Third Molar Surgery

Anesthetic Pharmacology and the Morbidly Obese Patient

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