Remifentanil does not affect human microglial immune activation in response to pro-inflammatory cytokines

Russo, Cinzia Dello; Cappoli, Natalia; Tabolacci, Elisabetta; Sollazzi, Liliana; Navarra, Pierluigi; Aceto, Paola

doi:10.17179/excli2022-5667

Cited by 3 publications

(3 citation statements)

References 46 publications

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“… 14 However, when we further expanded these initial observations, focusing on proinflammatory mediators, we demonstrated that RF, at clinically relevant concentrations, is not able to directly modulate the immune activation of human microglia. 19 …”

Section: Discussionmentioning

confidence: 99%

Remifentanil-induced hyperalgesia in healthy volunteers: a systematic review and meta-analysis of randomized controlled trials

Dello Russo,

Di Franco,

Tabolacci

et al. 2023

Pain

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Recent literature suggests that the withdrawal of remifentanil (RF) infusion can be associated with hyperalgesia in clinical and nonclinical settings. We performed a systematic review and a meta-analysis of randomized controlled trials with cross-over design, to assess the effect of discontinuing RF infusion on pain intensity and areas of hyperalgesia and allodynia in healthy volunteers. Nine studies were included. The intervention treatment consisted in RF infusion that was compared with placebo (saline solution). The primary outcome was pain intensity assessment at 30 ± 15 minutes after RF or placebo discontinuation, assessed by any pain scale and using any quantitative sensory testing. Moreover, postwithdrawal pain scores were compared with baseline scores in each treatment. Secondary outcomes included the areas (% of basal values) of hyperalgesia and allodynia. Subjects during RF treatment reported higher pain scores after discontinuation than during treatment with placebo [standardized mean difference (SMD): 0.50, 95% confidence interval (CI): 0.03-0.97; P = 0.04, I2 = 71%]. A significant decrease in pain scores, compared with baseline values, was found in the placebo treatment (SMD: −0.87, 95% CI: −1.61 to −0.13; P = 0.02, I2 = 87%), but not in the RF treatment (SMD: −0.28, 95% CI: −1.18 to 0.62; P = 0.54, I2 = 91%). The area of hyperalgesia was larger after RF withdrawal (SMD: 0.55; 95% CI: 0.27-0.84; P = 0.001; I2 = 0%). The area of allodynia did not vary between treatments. These findings suggest that the withdrawal of RF induces a mild but nonclinically relevant degree of hyperalgesia in HVs, likely linked to a reduced pain threshold.

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Section: Discussionmentioning

confidence: 99%

Remifentanil-induced hyperalgesia in healthy volunteers: a systematic review and meta-analysis of randomized controlled trials

Dello Russo,

Di Franco,

Tabolacci

et al. 2023

Pain

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“…However, we have recently shown that RF is not able to directly modulate the immune activation of human microglia at clinically relevant concentrations, although it may exert direct pro-nociceptive effects, through activation of the brain-derived neurotrophic factor signaling pathway. [ 51 52 53 ] The rate POCD did not vary when RF was used combined with different modalities of general anesthesia, i.e., sevoflurane-based (volatile) anesthesia versus propofol-based anesthesia (total intravenous anesthesia). [ 54 ] The study enrolled patients with coronary artery disease (CAD) undergoing non-cardiac interventions.…”

Section: Literature Searchmentioning

confidence: 99%

Perioperative analgesia in the elderly

Del Tedesco,

Sessa,

Xhemalaj

et al. 2023

Saudi Journal of Anaesthesia

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The administration of analgesic drugs in elderly patients should take into account age-related physiological changes, loss of efficiency of homeostatic mechanisms, and pharmacological interactions with chronic therapies. Underestimation of pain in patients with impaired cognition is often linked to difficulties in pain assessment. In the preoperative phase, it is essential to assess the physical status, cognitive reserve, and previous chronic pain conditions to plan effective analgesia. Furthermore, an accurate pharmacological history of the patient must be collected to establish any possible interaction with the whole perioperative analgesic plan. The use of analgesic drugs with different mechanisms of action for pain relief in the intraoperative phase is a crucial step to achieve adequate postoperative pain control in older adults. The combined multimodal and opioid-sparing strategy is strongly recommended to reduce side effects. The use of various adjuvants is also preferable. Moreover, the implementation of non-pharmacological approaches may lead to faster recovery. High-quality postoperative analgesia in older patients can be achieved only with a collaborative interdisciplinary team. The aim of this review is to highlight the perioperative pain management strategies in the elderly with a special focus on intraoperative pharmacological interventions.

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“…[ 57 ] This finding is also confirmed by preclinical studies on human microglia due to the lack of any toxic effect or neuroinflammatory action on the central nervous system (no effect on inflammatory mediators) but, rather, a neuroprotective action throughout the induced rise in basal BDNF production. [ 58 59 ]…”

Section: Introductionmentioning

confidence: 99%

Implication of age-related changes on anesthesia management

Luca,

Schipa,

Cambise

et al. 2023

Saudi Journal of Anaesthesia

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Elderly patients have a high risk of perioperative morbidity and mortality. Pluri-morbidities, polypharmacy, and functional dependence may have a great impact on intraoperative management and request specific cautions. In addition to surgical stress, several perioperative noxious stimuli such as fasting, blood loss, postoperative pain, nausea and vomiting, drug adverse reactions, and immobility may trigger a derangement leading to perioperative complications. Older patients have a high risk of major hemodynamic derangement due to aging of the cardiovascular system and associated comorbidities. The hemodynamic monitoring as well as fluid therapy should be the most accurate as possible. Aging is accompanied by decreased renal function, which is related to a reduction in renal blood flow, renal mass, and the number and size of functioning nephrons. Drugs eliminated predominantly by the renal route need dosage adjustments based on residual renal function. Liver mass, hepatic blood flow, and intrinsic metabolic activity are decreased in the elderly, and all drugs metabolized by the liver have a variable half-life, thus requiring dose reduction. Decreased neural plasticity contributes to a high risk for postoperative delirium. Monitoring of anesthesia depth should be mandatory to avoid overdosage of hypnotic drugs. Prevention of postoperative pulmonary complications requires both protective ventilation strategies and adequate recovery of neuromuscular function at the end of surgery. Avoidance of hypothermia cannot be missed. The aim of this review is to describe comprehensive strategies for intraoperative management plans tailored to meet the unique needs of elderly surgical patients, thus improving outcomes in this vulnerable population.

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Remifentanil does not affect human microglial immune activation in response to pro-inflammatory cytokines

Cited by 3 publications

References 46 publications

Remifentanil-induced hyperalgesia in healthy volunteers: a systematic review and meta-analysis of randomized controlled trials

Remifentanil-induced hyperalgesia in healthy volunteers: a systematic review and meta-analysis of randomized controlled trials

Perioperative analgesia in the elderly

Implication of age-related changes on anesthesia management

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