Low-dose remifentanil to suppress haemodynamic responses to noxious stimuli in cardiac surgery: a dose-finding study

Steinlechner, Barbara; Dworschak, Martin; Birkenberg, Beatrice; Lang, Tzu-Wang; Schiferer, Arno; Moritz, Andrea; Mora, Bruno; Rajek, Angela

doi:10.1093/bja/aem069

Cited by 22 publications

(11 citation statements)

References 22 publications

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“…The finding that remifentanil was found to reduce the duration of mechanical ventilation, time to extubation after sedation cessation, and ICU-LOS may be highly related to the unique pharmacokinetics and pharmacodynamics of remifentanil, namely, its rapid onset and offset, context-sensitive half-life that is hardly affected by the duration of infusion, and elimination that is independent of liver or renal function [ 14 , 15 ]. In the subgroups, the results of the studies comparing remifentanil with fentanyl showed a maximal mean difference of 3.85 hours.…”

Section: Discussionmentioning

confidence: 99%

Could remifentanil reduce duration of mechanical ventilation in comparison with other opioids for mechanically ventilated patients? A systematic review and meta-analysis

Zhu

Wang

et al. 2017

Crit Care

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BackgroundSedation and analgesia are commonly required to relieve anxiety and pain in mechanically ventilated patients. Fentanyl and morphine are the most frequently used opioids. Remifentanil is a selective μ-opioid receptor that is metabolized by unspecific esterases and eliminated independently of liver or renal function. Remifentanil has a rapid onset and offset and a short context-sensitive half-life regardless of the duration of infusion, which may lead to reductions in weaning and extubation. We aimed to compare the efficacy and safety of remifentanil to that of other opioids in mechanically ventilated patients.MethodsWe conducted a search to identify relevant randomized controlled studies (RCTs) in the PubMed, Embase, Cochrane Library and SinoMed databases that had been published up to 31 December 2016. The results were analysed using weighted mean differences (WMDs) and 95% confidence intervals (CIs).ResultsTwenty-three RCTs with 1905 patients were included. Remifentanil was associated with reductions in the duration of mechanical ventilation (mean difference -1.46; 95% CI -2.44 to -0.49), time to extubation after sedation cessation (mean difference -1.02; 95% CI -1.59 to -0.46), and ICU-LOS (mean difference -0.10; 95% CI -0.16 to -0.03). No significant differences were identified in hospital-LOS (mean difference -0.05; 95% CI -0.25 to 0.15), costs (mean difference -709.71; 95% CI -1590.98 to 171.55; I2 88%), mortality (mean difference -0.64; 95% CI -1.33 to 0.06; I2 87%) or agitation (mean difference -0.71; 95% CI -1.80 to 0.37; I2 93%).ConclusionsRemifentanil seems to be associated with reductions in the duration of mechanical ventilation, time to extubation after cessation of sedation, and ICU-LOS. No significant differences were identified between remifentanil and other opioids in terms of hospital-LOS, costs, mortality or agitation.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1789-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Could remifentanil reduce duration of mechanical ventilation in comparison with other opioids for mechanically ventilated patients? A systematic review and meta-analysis

Zhu

Wang

et al. 2017

Crit Care

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“…Remifentanil may lead to reduced cardiac output and hypotension. 23 It has also been suggested that sensitivity of peripheral alpha-adrenergic receptors is decreased in schizophrenic patients treated with antipsychotic agents such as haloperidol or chlorpromazine, 24 and that epinephrine 25 contained in lidocaine used as a local anaesthetic agent causes dilation of peripheral blood vessels. Anaesthesia for ordinary dental procedures might be excessively deep.…”

Section: Discussionmentioning

confidence: 99%

Anaesthesia for a morbidly obese patient with schizophrenia and intellectual disability

Asahi

Kawai

Sugimoto

et al. 2009

Southern African Journal of Anaesthesia and Analgesia

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We report the case of a morbidly obese woman with schizophrenia and intellectual disability who underwent dental treatment using general anaesthesia. The 38-year-old patient was 156 cm tall and weighed 140 kg, with a body mass index of 57.5 kg.m-2. Her developmental age was less than five or six years. She had been taking several antipsychotic agents, including haloperidol. Tracheal intubation was performed smoothly and anaesthesia was maintained uneventfully using propofol and remifentanil. This case demonstrates that the method of general anaesthesia presented here can be used safely in managing patients with these kinds of disabilities.

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“…Both these techniques provide excellent intra operative analgesia. Remifentanil infusion has the added advantage of reducing stress response to sternotomy (50), rapid titrability, a favorable context sensitive half time (51) allowing for rapid recovery, reducing coughing (52,53) and bucking on extubation.…”

Section: Induction and Maintenance Of Anaesthesiamentioning

confidence: 99%

Anaesthetic considerations for pectus repair surgery

Patvardhan

Martínez

2016

J. Vis. Surg.

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Repair of pectus is one of the most common congenital abnormality for which patient presents for thoracic surgery. In recent years, innovative minimally invasive techniques involving video assisted thoracoscopy for pectus repair have become the norm. Similarly, anaesthetic techniques have evolved to include principles of enhanced recovery, multimodal analgesia and innovative ultrasound guided neuraxial and nerve blocks. Adequate anaesthetic set up and monitoring including the use of real time intraoperative monitoring with transesophageal echocardiography (TOE) has enabled the anaesthetist to enhance patient safety by providing instantaneous imaging of cardiac compression and complications during surgery. In this review article we aim to provide non-systematic review and institutional experience of our anaesthetic strategy to provide effective peri-operative care in this patient group.

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Low-dose remifentanil to suppress haemodynamic responses to noxious stimuli in cardiac surgery: a dose-finding study

Cited by 22 publications

References 22 publications

Could remifentanil reduce duration of mechanical ventilation in comparison with other opioids for mechanically ventilated patients? A systematic review and meta-analysis

Could remifentanil reduce duration of mechanical ventilation in comparison with other opioids for mechanically ventilated patients? A systematic review and meta-analysis

Anaesthesia for a morbidly obese patient with schizophrenia and intellectual disability

Anaesthetic considerations for pectus repair surgery

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