Remifentanil and the brain

Fodale, Vincenzo; Schifilliti, Daniela; Praticò, C; Santamaria, L. B.

doi:10.1111/j.1399-6576.2007.01566.x

Cited by 71 publications

(46 citation statements)

References 72 publications

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“…The short context-sensitive half-life of remifentanil makes this drug a popular analgesic during balanced volatile anaesthesia, 16 and the addition of remifentanil to volatile agents does not seem to modify the BIS level when there is no painful stimulation. 17 The supplemental use of remifentanil did not significantly confound BIS measurements in this study.…”

Section: Discussionmentioning

confidence: 51%

Relationship of bispectral index to minimum alveolar concentration during isoflurane, sevoflurane or desflurane anaesthesia

Kim

Lee

2013

J Int Med Res

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Objective: To determine bispectral index (BIS) values produced by equipotent concentrations of commonly used volatile anaesthetics. Methods: Female patients undergoing thyroidectomy were randomly assigned to receive isoflurane, sevoflurane or desflurane anaesthesia. After induction, anaesthesia was maintained by the volatile agent at 1 minimum alveolar concentration and supplemented with remifentanil infusion. BIS values were recorded during 1 h surgical anaesthesia after a 15 min equilibrium phase. Results: Time-averaged BIS value during the study period was significantly lower in the desflurane group (n ¼ 29) than the sevoflurane group (n ¼ 27) (37.0 AE 4.9 vs 41.5 AE 5.9). Duration of deep hypnosis (BIS < 40) was significantly longer in the desflurane group than the sevoflurane group (40.2 AE 20.7 vs 24.3 AE 22.5 min). There were no significant differences in any parameter between the isoflurane group (n ¼ 27) and any other group. Conclusions: Desflurane produces a greater hypnotic effect than sevoflurane during equipotent anaesthesia. Management of volatile anaesthesia using predetermined minimum alveolar concentration targets can lead to an unnecessarily long duration of deep hypnosis.

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Section: Discussionmentioning

confidence: 51%

Relationship of bispectral index to minimum alveolar concentration during isoflurane, sevoflurane or desflurane anaesthesia

Kim

Lee

2013

J Int Med Res

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“…Briefl y, the animal was intubated aft er induction with fentanyl (31 μ g kg − 1 ), thiopental (5 mg kg − 1 ) and succinylcholine chloride (3 mg kg − 1 ), and the anaesthesia throughout the experiment was maintained with remifentanil (0.5 -2 μ g kg − 1 min − 1 ). Remifentanil is the standard μ -opioid that has been used throughout our previous monkey fMRI experiments 10,11,21 because of a number of benefi cial features at these concentrations: little eff ect on cerebral metabolism, negligible eff ects on neuronal excitability (as measured with motor-evoked potentials) and potential neuroprotective eff ects 56 . In our previous microstimulation fMRI experiments 10 , a comparison between the anaesthetized and awake state did not reveal any substantial diff erences in evoked BOLD responses.…”

Section: Methodsmentioning

confidence: 99%

Unravelling cerebellar pathways with high temporal precision targeting motor and extensive sensory and parietal networks

et al. 2012

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Increasing evidence has implicated the cerebellum in providing forward models of motor plants predicting the sensory consequences of actions. Assuming that cerebellar input to the cerebral cortex contributes to the cerebro-cortical processing by adding forward model signals, we would expect to fi nd projections emphasising motor and sensory cortical areas. However, this expectation is only partially met by studies of cerebello -cerebral connections. Here we show that by electrically stimulating the cerebellar output and imaging responses with functional magnetic resonance imaging, evoked blood oxygen level-dependant activity is observed not only in the classical cerebellar projection target, the primary motor cortex, but also in a number of additional areas in insular, parietal and occipital cortex, including sensory cortical representations. Further probing of the responses reveals a projection system that has been optimized to mediate fast and temporarily precise information. In conclusion, both the topography of the stimulation effects and its emphasis on temporal precision are in full accordance with the concept of cerebellar forward model information modulating cerebro-cortical processing.

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“…Remifentanil has short duration of action which allows earlier emergence and recovery. Moreover remifentanil reduces mean arterial pressure and cerebral perfusion pressure 9 .…”

Section: Introductionmentioning

confidence: 99%

Early postoperative recovery after intracranial surgical procedures. Comparison of the effects of sevoflurane and desflurane

et al. 2016

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PURPOSE:To compared the effects of sevoflurane and desflurane on early anesthesia recovery in patients undergoing to craniotomy for intracranial lesions. METHODS:After IRB approval, the study included 50 patients aged 18-70 years who had ASA physical statuses of I-II and were scheduled for intracranial surgery. Patients were randomly divided into two groups: sevoflurane and desflurane. Anaesthesia was routinely induced in all patients followed by desflurane 5%-6% or sevoflurane 1%-2%. Moreover remifentanil infusion (0.05-0.2 mcg/ kg/min) was adjusted to maintain mean arterial pressure (MAP) within 20% baseline and heart rate <90 bpm. Postoperatively, patients were evaluated over time for responses to painful stimulus, eye opening, hand squeezing, extubation, orientation and time required to achieve a Modified Aldrete Score of 9-10. Parametric and non-parametric data were assessed using Student's t-and Mann-Whitney U tests, respectively. A p<0.05 was taken as statistically significant. RESULTS:The times to responses to painful stimuli (7.7±2.7 vs. 4.8±1.7 min.; p<0.001), emergence (9.5±2.81 vs. 6.3±2.2 min.; Early postoperative recovery after intracranial surgical procedures. Comparison of the effects of sevoflurane and desflurane

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Remifentanil and the brain

Abstract: The knowledge of the influence of remifentanil on brain functions is crucial before routine use in neuroanesthesia to improve anesthesia performance and patient safety as well as outcome.

Cited by 71 publications

References 72 publications

Relationship of bispectral index to minimum alveolar concentration during isoflurane, sevoflurane or desflurane anaesthesia

Relationship of bispectral index to minimum alveolar concentration during isoflurane, sevoflurane or desflurane anaesthesia

Unravelling cerebellar pathways with high temporal precision targeting motor and extensive sensory and parietal networks

Early postoperative recovery after intracranial surgical procedures. Comparison of the effects of sevoflurane and desflurane

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