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1.
Medicine (Baltimore) ; 100(38): e27275, 2021 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-34559131

RESUMO

BACKGROUND AND AIMS: To identify the efficacy and safety of remifentanil when compared with other opioids in adult critically ill patients. METHODS: We searched for studies in the Cochrane Library, MEDLINE, and EMBASE that had been published up to May 31st, 2019. Randomized clinical trials using remifentanil comparing with other opioids for analgesia were included. Two reviewers independently applied eligibility criteria, assessed quality, and extracted data. Duration of mechanical ventilation was the primary outcome, and secondary outcomes included weaning time, intensive care unit (ICU), length of stay (LOS), hospital LOS, mortality, side effects, and costs. RESULTS: Fifteen studies with 1233 patients were included. Remifentanil was associated with a significant reduction in the duration of mechanical ventilation in the adult ICU patients when compared with other opioids (P = .01). Remifentanil also reduced the weaning time (P = .02) and the ICU LOS when compared with other opioids (P = .01). There was no difference in the hospital LOS (P = .15), side effects (P = .39), and mortality (P = .79) between remifentanil and other opioids, what's more, remifentanil increased the costs of anesthesia (P < .001) but did not increase cost of hospitalization (P = .30) when comparing with other opioids. CONCLUSIONS: Remifentanil reduced the duration of mechanical ventilation, weaning time, and ICU LOS when compared with other opioids in adult critically ill patients. Higher quality RCTs are necessary to prove our findings. PROSPERO REGISTRATION NUMBER: CRD42016041438.


Assuntos
Remifentanil/farmacologia , Fatores de Tempo , Adulto , Analgésicos Opioides/farmacocinética , Analgésicos Opioides/farmacologia , Estado Terminal/terapia , Humanos , Unidades de Terapia Intensiva/organização & administração , Tempo de Internação , Dor/tratamento farmacológico , Remifentanil/farmacocinética , Respiração Artificial/métodos , Desmame do Respirador/métodos
2.
Croat Med J ; 62(3): 233-240, 2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34212560

RESUMO

AIM: To evaluate the consumption of remifentanil (as a primary end-point), analgesia, sedation, hemodynamics, respiratory effects, and surgeon and patient satisfaction (as a secondary end-point) with dexmedetomidine sedation compared with those of remifentanil sedation in patients undergoing vitreoretinal surgery. METHODS: Patients subjected to retinal ophthalmic surgical procedures were randomized to one of two intraoperative sedation groups: one group (n=21) received intranasal dexmedetomidine plus intravenous remifentanil (DEX-REMI group), and the other group (n=19) received intravenous remifentanil only (REM group). The treatment was placebo-controlled. The sedation level was controlled according to the bispectral index, with target values between 80%-90%. Patient levels of comfort, sedation, and pain were documented. The number of intraoperative complications and the level of satisfaction were assessed. Remifentanil consumption and hemodynamic parameters were also included in the statistical analysis. RESULTS: The level of remifentanil consumption was significantly lower in the DEX-REMI group, but combination sedation improved the surgeon's, anesthesiologist's, and patients' satisfaction scores. Importantly, the number of complications was zero in the DEX-REMI group, while eight cases of complications were noted in the REM group. The DEX-REMI group showed lower mean minimal arterial pressure, but it was still in the normotensive range. CONCLUSIONS: For patients undergoing ophthalmic procedures, sedation with a combination of intranasal dexmedetomidine and an intravenous infusion of remifentanil provides lower remifentanil consumption, better satisfaction scores, and a lower complication rate than sedation with a remifentanil infusion alone.


Assuntos
Dexmedetomidina , Dexmedetomidina/farmacologia , Hemodinâmica , Humanos , Hipnóticos e Sedativos/farmacologia , Piperidinas/farmacologia , Remifentanil/farmacologia
3.
Am J Physiol Gastrointest Liver Physiol ; 321(4): G367-G377, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34261364

RESUMO

Remifentanil impairs swallowing, and disturbed accommodation to bolus volume may be one of the underlying causes. It is not fully understood whether remifentanil-induced swallowing dysfunction is mediated by peripheral or central mechanisms. So, this study aimed to investigate if remifentanil-induced swallowing dysfunction is dependent on the bolus volume and whether the effect of remifentanil could be counteracted by methylnaltrexone, a peripherally acting opioid antagonist. Nineteen healthy volunteers were included in this double-blinded, randomized, placebo-controlled, crossover study. Study participants received target-controlled remifentanil infusions and placebo infusions in a randomized order. Methylnaltrexone was administered by intravenous injection of doses of 0.3 mg/kg. Recordings of pressure and impedance data were acquired using a combined manometry and impedance solid-state catheter. Data were analyzed from three series of bolus swallows, baseline, during study medication exposure, and 15 min after methylnaltrexone. Remifentanil induced significant effects on multiple pharyngeal and esophageal function parameters. No significant differences in remifentanil-induced swallowing dysfunction related to different bolus volumes were found. Pharyngeal effects of remifentanil were not significantly counteracted by methylnaltrexone, whereas on the distal esophageal level, effects on distension pressures were counteracted. Changes in pharyngeal and esophageal pressure flow variables were consistent with previous results on remifentanil-induced swallowing dysfunction and uniform across all bolus volumes. The effects of remifentanil on the pharyngeal level and on the proximal esophagus appear to be predominantly centrally mediated, whereas the effects of remifentanil on the distal esophagus may be mediated by both central and peripheral mechanisms.NEW & NOTEWORTHY In this randomized controlled trial, we used the "Swallow Gateway" online platform to analyze the effects of remifentanil on pharyngeal and esophageal swallowing. It is not fully understood whether remifentanil-induced swallowing dysfunction is mediated by peripheral or central mechanisms. By using methylnaltrexone, we demonstrated that effects of remifentanil on pharyngeal swallowing were predominantly centrally mediated, whereas its effects on the distal esophagus may be mediated by both central and peripheral mechanisms.


Assuntos
Analgésicos Opioides/farmacologia , Deglutição , Esôfago/efeitos dos fármacos , Naltrexona/análogos & derivados , Antagonistas de Entorpecentes/farmacologia , Faringe/efeitos dos fármacos , Remifentanil/farmacologia , Adulto , Analgésicos Opioides/administração & dosagem , Antagonismo de Drogas , Esôfago/fisiologia , Feminino , Voluntários Saudáveis , Humanos , Injeções Intravenosas , Masculino , Contração Muscular , Relaxamento Muscular , Naltrexona/administração & dosagem , Naltrexona/farmacologia , Antagonistas de Entorpecentes/administração & dosagem , Faringe/fisiologia , Compostos de Amônio Quaternário/administração & dosagem , Compostos de Amônio Quaternário/farmacologia , Remifentanil/administração & dosagem
4.
J Toxicol Sci ; 46(6): 263-271, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34078833

RESUMO

Myocardial ischemia/reperfusion (I/R) injury could lead to severe cardiovascular ischemic disease, including myocardial infarction and contractile dysfunction. Remifentanil demonstrated protective effect on myocardial I/R injury. The underlying pathophysiological mechanism was then investigated in this study. In the current study, primary cardiomyocytes were isolated from rats, and then preconditioned with remifentanil. Rats, tail vein injected with miR-205 antagomir, were subjected to infusion of remifentanil, and then subjected to regional ischemia followed by reperfusion. The results demonstrated that cell viability of hypoxia/reoxygenation-induced cardiomyocytes was increased post remifentanil, while the apoptosis was decreased accompanied with reduced cleaved caspase-3 expression. Hypoxia/reoxygenation treatment increased miR-205 and decreased PINK1 (PTEN induced putative kinase 1) expression. However, preconditioning with remifentanil reduced miR-205 and enhanced PINK1. Moreover, over-expression of miR-205 decreased PINK1 expression and counteracted the effects of remifentanil-induced increase of cell viability and decrease of cell apoptosis in hypoxia/reoxygenation-induced cardiomyocytes. Injection with miR-205 antagomir improved remifentanil-induced decrease of infarct size and LDH (lactic acid dehydrogenase) activity in rat model with I/R injury. In conclusion, miR-205 might participate in the protective effect of remifentanil in rat myocardial I/R injury via regulation of PINK1, providing a potential target for amelioration of cardiovascular ischemic disease.


Assuntos
MicroRNAs/metabolismo , Isquemia Miocárdica/genética , Isquemia Miocárdica/prevenção & controle , Traumatismo por Reperfusão Miocárdica/genética , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Proteínas Quinases/genética , Proteínas Quinases/metabolismo , Remifentanil/farmacologia , Remifentanil/uso terapêutico , Animais , Apoptose/efeitos dos fármacos , Caspase 3/genética , Caspase 3/metabolismo , Sobrevivência Celular/efeitos dos fármacos , Células Cultivadas , Expressão Gênica/efeitos dos fármacos , Regulação da Expressão Gênica , MicroRNAs/genética , MicroRNAs/fisiologia , Isquemia Miocárdica/metabolismo , Traumatismo por Reperfusão Miocárdica/metabolismo , Miócitos Cardíacos/efeitos dos fármacos , Ratos Sprague-Dawley
5.
Anesth Prog ; 68(1): 10-18, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33827126

RESUMO

The objectives of this research were to investigate (a) what was the most effective infusion rate of remifentanil and (b) the degree to which sympathomimetic effects were involved with cardiovascular stimulation by using a power spectral analysis of heart rate variability (HRV). A total of 63 healthy individuals scheduled for sagittal split ramus osteotomy were enrolled and randomly allocated to 1 of 3 groups: remifentanil infusion rate of 0.1, 0.2, or 0.4 µg/kg/min. Anesthesia was maintained with remifentanil and propofol. Before the surgical procedure, 2% lidocaine containing 12.5 µg/mL epinephrine was administered in the surgical field for local anesthesia. Systolic blood pressure (SBP), heart rate (HR), low-frequency (LF) and high-frequency (HF) components in HRV power spectral analysis, and the LF/HF ratio were analyzed. Increases in SBP and HR were observed after local anesthesia in all 3 groups, but no significant differences were observed between the groups. Remifentanil infusion at 0.1 µg/kg/min may be appropriate to minimize cardiovascular stimulation caused by exogenous epinephrine from local anesthesia. Although a rise in the LF/HF ratio was observed after local anesthesia in all groups, no relationship was observed between the cardiovascular changes and the increase in LF/HF ratio. This suggests that sympathomimetic effects are involved to a lesser extent with the cardiovascular stimulation caused by exogenous epinephrine.


Assuntos
Anestesia Local , Anestésicos Locais , Anestésicos Intravenosos/efeitos adversos , Anestésicos Locais/efeitos adversos , Pressão Sanguínea , Epinefrina/efeitos adversos , Frequência Cardíaca , Humanos , Piperidinas/efeitos adversos , Remifentanil/farmacologia
6.
Biochem Biophys Res Commun ; 557: 69-76, 2021 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-33862462

RESUMO

Remifentanil is a potent, short-acting opioid analgesic drug that can protect tissues from ischemia and reperfusion injury though anti-inflammatory effects. However, the utility of remifentanil in liver regeneration after hepatectomy is not known. Using a 70% hepatectomy mouse model (PHx), we found that preconditioning animals with 4 µg/kg remifentanil enhanced liver regeneration through supporting hepatocyte proliferation but not through anti-inflammatory effects. These effects were also phenocopied in vitro where 40 mM remifentanil promoted the proliferation of primary mouse hepatocyte cultures. We further identified that remifentanil treatment increased the expression of ß-arrestin 2 in vivo and in vitro. Demonstrating specificity, remifentanil preconditioning failed to promote liver regeneration in liver-specific ß-arrestin 2 knockout (CKO) mice subjected to PHx. While remifentanil increased the expression of activated (phosphorylated)-ERK and cyclin D1 in PHx livers, their levels were not significantly changed in remifentanil-treated CKO mice nor in WT mice pretreated with the ERK inhibitor U0126. Our findings suggest that remifentanil promotes liver regeneration via upregulation of a ß-arrestin 2/ERK/cyclin D1 axis, with implications for improving regeneration process after hepatectomy.


Assuntos
Ciclina D1/metabolismo , Regeneração Hepática , Sistema de Sinalização das MAP Quinases/efeitos dos fármacos , Remifentanil/farmacologia , Traumatismo por Reperfusão/terapia , beta-Arrestina 2/metabolismo , Analgésicos Opioides/farmacologia , Animais , Proliferação de Células/fisiologia , Células Cultivadas , Modelos Animais de Doenças , Hepatectomia , Hepatócitos/efeitos dos fármacos , Hepatócitos/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Camundongos Transgênicos , Traumatismo por Reperfusão/metabolismo , Traumatismo por Reperfusão/patologia , Regulação para Cima
7.
Heart Surg Forum ; 24(2): E233-E238, 2021 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-33798062

RESUMO

BACKGROUND: To investigate the safety and efficacy of remifentanil combined with dexmedetomidine in fast-track cardiac anesthesia (FTCA) for transthoracic device closure of atrial septal defect (ASD) in pediatric patients. METHODS: A retrospective analysis was performed on 61 cases of children undergoing ASD closure through a small thoracic incision from January 2018 to January 2020. According to whether FTCA was administered, they were divided into group F (fast-track anesthesia, n = 31) and group R (routine anesthesia, n = 30). RESULTS: There was no significant difference in general preoperative data, perioperative hemodynamics, or postoperative pain scores between the 2 groups (P > .05). The postoperative sedation score of group F was higher than that of group R 1 and 4 hours after extubation. Meanwhile, duration of mechanical ventilation and length of postoperative intensive care unit (ICU) stay of group F were significantly shorter than those of group R (P < .05). No serious anesthesia-related complications occurred. CONCLUSION: Remifentanil combined with dexmedetomidine in FTCA for transthoracic device closure of ASD in pediatric patients is safe and effective, is worthy of clinical promotion, and can benefit more children.


Assuntos
Anestesia/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Dexmedetomidina/farmacologia , Comunicação Interatrial/cirurgia , Remifentanil/farmacologia , Dispositivo para Oclusão Septal , Analgésicos não Narcóticos/farmacologia , Analgésicos Opioides/farmacologia , Pré-Escolar , Combinação de Medicamentos , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos
8.
Minerva Anestesiol ; 87(6): 640-647, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33688696

RESUMO

BACKGROUND: Mechanism underlying the hypotension during anesthetic induction in elderly patients is inferred to differ from that in younger patients due to structural changes in arteries. The aim of the study was to determine if a decrease in cardiac output (CO) or systemic vascular resistance (SVR) is the main mechanism of the hypotension. METHODS: Fifty-six patients comprising 28 healthy elderly patients aged 75-90 years (group E) and 28 healthy younger patients aged 20-40 years (group Y) were enrolled. General anesthesia was induced with propofol (1.2 mg/kg, group E; 2 mg/kg, group Y), remifentanil (0.15 µg/kg/min, group E; 0.3 µg/kg/min, group Y) and rocuronium. Primary outcome was to compare serial changes in PI of Radical-7TM, SVR, CO and stroke volume variations (SVV) of ClearSightTM (Edwards Lifesciences Corp., Irvine, CA, USA) during the five-minute period from propofol administration until intubation. RESULTS: The degree of increase in PI and reduction in SVR in group Y were significantly greater than those in group E (P<0.01 with repeated measure ANOVA). The degree of reduction in CO and increase in SVV were significantly larger in group E (P<0.01). All values of mean arterial blood pressure measured during the five-minute correlated negatively with PI in group Y (r=0.44, P<0.01) and positively with CO in group E (r=0.4, P<0.01). CONCLUSIONS: The main mechanisms of hypotension during anesthetic induction contribute to the decrease in CO in elderly and reduction of SVR in younger. PI only shows the vascular tone of a finger but can be a surrogate for SVR.


Assuntos
Anestésicos , Hipotensão , Propofol , Idoso , Anestésicos/farmacologia , Anestésicos Intravenosos/farmacologia , Pressão Sanguínea , Humanos , Hipotensão/induzido quimicamente , Índice de Perfusão , Propofol/farmacologia , Remifentanil/farmacologia
9.
Microvasc Res ; 135: 104132, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33421433

RESUMO

Several studies report flow disturbance and microcirculation disorders upon anesthesia treatment. These alterations are often related to blood rheology changes. In this work, it was attempted to make a detailed description of the alterations in erythrocyte mechanical properties by the action of propofol, remifentanil, and vecuronium. For this, an in vitro study was performed on red blood cell samples from healthy donors incubated with solutions of propofol (4 µg/mL whole blood), remifentanil (10 ng/mL plasma), and vecuronium (0.15 µg/mL plasma). Erythrocyte viscoelastic parameters were determined by octuplicate using a Reómetro Eritrocitario. Also, a Wilcoxon signed rank-test with Yates correction for continuity was performed to analyze the overall alteration in the mechanical properties of erythrocytes. Statistical analysis showed that the three studied anesthetics changed the erythrocyte mechanical properties at different parts of the membrane. These results would imply an interaction of these anesthetics with the erythrocyte membrane. Finally, this could conduce to alterations in microcirculation.


Assuntos
Analgésicos Opioides/farmacologia , Anestésicos Intravenosos/farmacologia , Eritrócitos/efeitos dos fármacos , Fármacos Neuromusculares não Despolarizantes/farmacologia , Propofol/farmacologia , Remifentanil/farmacologia , Brometo de Vecurônio/farmacologia , Adulto , Citoesqueleto/efeitos dos fármacos , Módulo de Elasticidade , Deformação Eritrocítica/efeitos dos fármacos , Membrana Eritrocítica/efeitos dos fármacos , Humanos , Masculino , Viscosidade , Adulto Jovem
10.
Sci Rep ; 11(1): 1511, 2021 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-33452350

RESUMO

This study aimed to compare the effects of volatile anesthesia and total intravenous anesthesia (TIVA) on syndecan-1 shedding in patients with gastric cancer undergoing minimally invasive gastrectomy. Patients were randomly assigned to either the Volatile (n = 68) or the TIVA (n = 68) group. Anesthesia was maintained with sevoflurane/remifentanil or propofol/remifentanil in the Volatile and TIVA groups, respectively. Serum syndecan-1 was evaluated at pre-operation, end of operation, and postoperative day (POD) 1. Inflammatory markers including white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP), were also measured at pre-operation, end of operation, and POD 1, 2, 3, and 5. The TIVA group showed significantly lower levels of syndecan-1 at the end of the operation compared to the Volatile group; however, no difference was seen between the groups at POD 1. The WBC count and NLR were significantly lower in the TIVA group at the end of the operation than the Volatile group, but there were no differences between the groups at POD 1, 2, 3, and 5. CRP levels were similar between the groups at all time points. In conclusion, despite TIVA being superior to volatile anesthesia in protecting endothelial glycocalyx during the operation, both did not prevent postoperative syndecan-1 shedding after gastrectomy.Clinical trial registration number: NCT04183296 (ClinicalTrial.gov, 03/12/2019).


Assuntos
Anestesia por Inalação/métodos , Anestesia Intravenosa/métodos , Sindecana-1/metabolismo , Idoso , Período de Recuperação da Anestesia , Anestesia Geral/métodos , Anestésicos Inalatórios/farmacologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Propofol/farmacologia , Remifentanil/farmacologia , Sevoflurano/farmacologia , Neoplasias Gástricas/metabolismo , Neoplasias Gástricas/cirurgia , Sindecana-1/análise , Sindecana-1/sangue
11.
Int Tinnitus J ; 24(2): 60-64, 2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33496413

RESUMO

INTRODUCTION: One of the most important problems during cosmetic nose surgery is excessive bleeding. Controlled hypotension is an appropriate technique for reducing intraoperative bleeding as well as satisfactory and non-bloody surgical field. Different drugs, such as dexmedetomidine and remifentanil, are used to control hypotension. The aim of this study was to compare the effect of dexmedetomidine and remifentanil on the creation of control hypotension during rhinoplasty. MATERIAL AND METHOD: This study is a randomized, double-blind clinical trial which was performed on 60 patients randomly divided into two groups D (Dexmedetomidine) and R (Remifentanil). In group D (0.5 mg / kg / h) Dexmedetomidine infusion and in group R (50-100 µg / kg / h) Remifentanil infusion. The study groups were compared in terms of hemodynamics and intraoperative bleeding. The data obtained from completed questionnaires were analyzed using SPSS software, T-test and ANOVA statistical tests and were presented in tables and statistical charts. RESULTS: The results of this study showed that the mean MAP (Mean Arterial Pressure) was significantly lower in remifentanil group patients than in dexmedetomidine group, while the intraoperative bradycardia rate was different at various time. CONCLUSION: During rhinoplasty surgery, both dexmedetomidine and remifentanil were effective in controlling hypotension and reducing intraoperative bleeding, but the effect of remifentanil was more pronounced than dexmedetomidine.


Assuntos
Dexmedetomidina , Hipotensão Controlada , Rinoplastia , Dexmedetomidina/farmacologia , Humanos , Piperidinas/farmacologia , Remifentanil/farmacologia
12.
Drug Alcohol Depend ; 218: 108369, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33109461

RESUMO

BACKGROUND: Preclinical studies into drug vs. nondrug choice have emerged to better model and investigate the neurobehavioral mechanisms underlying drug preference. Current literature has suggested that drugs of abuse have inherently low value, thus promoting food preference. Herein, we examined remifentanil vs. food choice to test both the relative value hypothesis and the 'direct effects' (pharmacological effects of drugs on alternative reinforcers) hypothesis of opioid preference. METHODS: Adult male rats were trained under two choice procedures (controlled vs. uncontrolled reinforcer frequency) for remifentanil vs. food choice. Furthermore, a series of procedural manipulations known to affect drug reinforcement were tested under both choice procedures. Using remifentanil self-administration data, pharmacokinetic profiles were calculated and analyzed to determine if opioid intake was related to opioid preference. RESULTS: Both choice procedures produced dose-dependent preference. Moreover, procedural manipulations produced comparable changes in remifentanil preference under both choice procedures. In addition, calculated pharmacokinetic data revealed that preference was dissociable from intake under the controlled reinforcer frequency choice procedure. CONCLUSIONS: When compared to the 'direct effects' hypothesis, remifentanil preference was better predicted by the relative value hypothesis, formalized in generalized matching. Use of a controlled reinforcer frequency schedule successfully removed the drug preference-intake confound found in most drug-choice procedures. Importantly, drug preference under the controlled reinforcer frequency schedule remained sensitive to procedural manipulations known to affect drug reinforcement. Thus, given that differential drug intake itself affects neurobiological measurements, future use of controlled reinforcer frequency schedules may help to better isolate the neurobehavioral mechanisms that mediate opioid preference.


Assuntos
Analgésicos Opioides/farmacologia , Preferências Alimentares/efeitos dos fármacos , Remifentanil/farmacologia , Analgésicos Opioides/administração & dosagem , Animais , Comportamento de Escolha/efeitos dos fármacos , Condicionamento Operante/efeitos dos fármacos , Relação Dose-Resposta a Droga , Masculino , Ratos , Esquema de Reforço , Reforço Psicológico , Autoadministração
13.
Acta Anaesthesiol Scand ; 65(3): 335-342, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33165918

RESUMO

BACKGROUND: Pre-administration of remifentanil in target-controlled propofol and remifentanil anaesthesia could prolong the time of onset of muscle relaxation owing to haemodynamic effects, thereby prolonging the time to tracheal intubation. Although the sympatholytic effects of remifentanil result in bradycardia and hypotension, these responses can be attenuated by the administration of atropine. Therefore, we investigated whether prophylactic administration of atropine could prevent the prolongation of the time to tracheal intubation. METHODS: Sixty-four patients were included in this study. They were randomised into Group A (atropine 0.5 mg, n = 32) and Group S (saline 0.9%, n = 32), immediately before the pre-administration of remifentanil. The primary outcome was the time to tracheal intubation and the secondary outcomes were rocuronium onset time, time to loss of consciousness (LOC), time to reach a value of 60 on the bispectral index (BIS) and haemodynamic variables. RESULTS: The median [Interquartile range] of the time to tracheal intubation was 240 [214, 288]s in Group S and 190 [176, 212]s in Group A(median difference: 50 s, 95% confidence interval: 27-80 s, P = .001). Rocuronium onset time was significantly decreased in Group A compared to that in Group S (129 [110, 156] vs 172 [154, 200], P = .001). The times to LOC and reach 60 on the BIS were not significantly different between the two groups. Cardiac output(CO) and heart rate were less decreased in Group A than in Group S (P = .02, P < .001, respectively). CONCLUSIONS: Prophylactic administration of atropine could compensate for the reduction in CO in cases pre-administered with remifentanil in target-controlled propofol and remifentanil anaesthesia. This in turn prevented the prolongation of rocuronium onset time and reduced the time to tracheal intubation.


Assuntos
Atropina , Propofol , Anestésicos Intravenosos/farmacologia , Pressão Sanguínea , Frequência Cardíaca , Humanos , Intubação Intratraqueal , Piperidinas/farmacologia , Propofol/farmacologia , Remifentanil/farmacologia
14.
Semin Cardiothorac Vasc Anesth ; 25(1): 74-75, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32664787

RESUMO

In this letter, the authors wonder about the need to apply some of the precautions that have been repeatedly suggested during the recent COVID-19 (coronavirus disease 19) pandemic not only to suspected or documented cases of infection but also to all the new cases entering the hospital. In this regard, orotracheal intubation has been universally recognized as a maneuver with a high risk of viral transmission. On the other hand, rapid sequence induction, which represents the gold standard for limiting the risk of transmission for health care professionals, implies side effects that can be potentially harmful for patients with impaired hemodynamics. In this regard, the authors report a particular type of rapid induction that they are performing in a systematic way during the recent pandemic in cardiac surgery patients. This is performed after the patient reaches a deep analgesic plan, thanks to the unique characteristics of the opioid remifentanil. This type of induction, already tested in vasculopathic patients who underwent carotid surgery, is characterized by great hemodynamic stability and is very advantageous, in the writer's experience, when rapid sequence induction has to be systematically applied to cardiovascular patients, especially if you only want to protect operators.


Assuntos
COVID-19/epidemiologia , Intubação Intratraqueal/métodos , Remifentanil/farmacologia , SARS-CoV-2 , Humanos
15.
J Vet Med Sci ; 83(1): 62-68, 2021 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-33191385

RESUMO

The aim of this study was to compare changes in tissue blood flow and tissue oxygen tension in the masseter muscle and mandibular bone marrow induced by remifentanil under desflurane or sevoflurane anesthesia. Eleven male tracheotomized Japan White rabbits were anesthetized with desflurane or sevoflurane under mechanical ventilation. The order of the inhalation of desflurane or sevoflurane was randomized. Desflurane or sevoflurane was administered at 1.0 minimum alveolar concentration and remifentanil was infused at 0.4 µg/kg/min. Observed variables included heart rate (HR), blood pressure (BP), common carotid artery blood flow (CCBF), mandibular bone marrow tissue blood flow (BBF), masseter muscle tissue blood flow (MBF), mandibular bone marrow tissue oxygen tension (PbO2), and masseter muscle tissue oxygen tension (PmO2). Two way repeated measures ANOVA showed no interaction between volatile anesthetics and remifentanil infusion except for MBF. There were significant differences in HR, SBP, DBP, MAP and CCBF between desflurane and sevoflurane groups. There were also significant differences in HR, SBP, DBP, MAP, CCBF, BBF and PbO2 before, during and after remifentanil infusion. Desflurane reduced tissue blood flow in the masseter muscle and mandibular bone marrow while better maintained HR and BP than sevoflurane. Under remifentanil infusion, although both anesthetics reduced tissue blood flow, tissue oxygen tension was maintained in masseter muscle and mandibular bone marrow.


Assuntos
Anestesia , Anestésicos Inalatórios , Isoflurano , Éteres Metílicos , Anestesia/veterinária , Anestésicos Inalatórios/farmacologia , Anestésicos Intravenosos/farmacologia , Animais , Pressão Sanguínea , Medula Óssea , Desflurano/farmacologia , Isoflurano/farmacologia , Japão , Masculino , Músculo Masseter , Éteres Metílicos/farmacologia , Oxigênio , Coelhos , Fluxo Sanguíneo Regional , Remifentanil/farmacologia , Língua
16.
Eur J Pharmacol ; 890: 173639, 2021 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-33065095

RESUMO

Drug-drug interactions can substantially change pharmacological effects of the individual substances involved. For the use of sedatives or anaesthetics, having knowledge of the extent and characteristics of such interactions is crucial for ensuring the proper protection of patients undergoing any kind of sedation. Remimazolam is a new ultra-short acting benzodiazepine that is currently under development for intravenous use in procedural sedation and general anaesthesia. It exhibits a fast onset and fast offset which enables a more rapid recovery than currently available drugs in that class, such as midazolam. The purpose of this study was to more closely investigate the sedative properties and pharmacodynamic drug-drug interaction potential of remimazolam with the opioid analgesic remifentanil and compare it with other commonly used sedatives - midazolam and propofol. For this purpose, six Cynomolgus monkeys received escalating doses of remimazolam, propofol, and midazolam intravenously without or with concurrent remifentanil. Sedation was evaluated using a general sedation scale that included monitoring exploratory and avoidance behaviour, responses to sensory stimuli, posture and gait, and eyelid position as endpoints. Based on the results, sedative doses were calculated to allow evaluation of pharmacological drug-drug interaction with remifentanil. Remimazolam induced dose-dependent and consistent sedative effects in each endpoint tested and showed a high degree of synergism with remifentanil. Midazolam showed a comparable synergism while the interaction between propofol and remifentanil was less pronounced.


Assuntos
Analgésicos Opioides/farmacologia , Benzodiazepinas/farmacologia , Hipnóticos e Sedativos/farmacologia , Midazolam/farmacologia , Propofol/farmacologia , Remifentanil/farmacologia , Administração Intravenosa , Analgésicos Opioides/administração & dosagem , Animais , Benzodiazepinas/administração & dosagem , Estudos Cross-Over , Interações Medicamentosas , Hipnóticos e Sedativos/administração & dosagem , Macaca fascicularis , Masculino , Midazolam/administração & dosagem , Propofol/administração & dosagem , Remifentanil/administração & dosagem
17.
Minerva Anestesiol ; 87(3): 302-311, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33300323

RESUMO

BACKGROUND: Remifentanil is a commonly used opioid analgesic during anesthesia in children. Objective measurement of pain is required for adequate dosing of remifentanil. We investigated whether pupillometry-guided remifentanil administration can reduce intraoperative consumption of remifentanil in children. METHODS: We performed a single-blinded, prospective, randomized controlled trial from December 2018 through June 2019. Children who were 3-12 years of age and classified as having an American Society of Anesthesiologists physical status I-II and undergoing elective surgery under general anesthesia were included. Fifty-six fulfilled the inclusion criteria, and fifty-four completed the study. Participants were randomly assigned to either a pupillometry or conventional group. Patients in both groups received target-controlled infusion of remifentanil. In the pupillometry group, the adjustment of the remifentanil effect site concentration was determined by the pupillary diameter, whereas in the conventional group, the adjustment was based on the anesthesiologist's experience. Primary outcome was intraoperative remifentanil consumption, divided by patient weight and infusion time (ng kg-1 min-1). RESULTS: Remifentanil consumption was reduced by 25% in the pupillometry group compared to the conventional group (116.7±56.0 ng kg-1 min-1 vs. 155.8±64.9 ng kg-1 min-1, respectively; P=0.02). There were no differences in intra- and postoperative blood pressure and heart rate. The incidences of postoperative desaturation or nausea/vomiting were not significantly different. CONCLUSIONS: Pupillometry-guided remifentanil administration in children undergoing general anesthesia can reduce the intraoperative remifentanil consumption.


Assuntos
Analgésicos Opioides , Anestesia Geral , Analgésicos Opioides/farmacologia , Criança , Frequência Cardíaca , Humanos , Estudos Prospectivos , Remifentanil/farmacologia
18.
J Vet Med Sci ; 83(2): 285-296, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33310997

RESUMO

We evaluated changes in cardiovascular and renal functions as well as arginine vasopressin (AVP) secretion, with remifentanil and dexmedetomidine administration alone or in combination in sevoflurane-anesthetized dogs. Six healthy adult Beagle dogs received one of the following four treatments in a randomized crossover study: saline (C), remifentanil alone at successively increasing doses (R; 0.15, 0.60, and 2.40 µg/kg/min), dexmedetomidine alone (D; 0.5 µg/kg intravenously for initial 10 min followed by a constant rate infusion at 0.5 µg/kg/hr), and a combination of remifentanil and dexmedetomidine at the above-mentioned doses (RD). Sevoflurane doses were adjusted to 1.5 times of minimum alveolar concentration (MAC) equivalent according to MAC-sparing effects with remifentanil and dexmedetomidine as previously reported. Cardiovascular measurements, renal function data, and plasma AVP concentrations were determined before and every 60 min until 180 min after drug administration as per each treatment. In the R, D and RD, heart rate significantly decreased and mean arterial pressure significantly increased from baseline or with C. Cardiac index significantly decreased and systemic vascular resistance index increased with D and RD. Oxygen extraction ratio, renal blood flow, and glomerular filtration rate were not affected. The plasma AVP concentrations significantly decreased in D and RD, but increased in R. Only in D, the natriuresis was elicited. The combination of remifentanil and dexmedetomidine in sevoflurane-anesthetized dogs was acceptable in terms of the hemodynamics, oxygenation, and renal function. Remifentanil may interfere with dexmedetomidine-induced diuresis and inhibition of AVP secretion.


Assuntos
Anestésicos Inalatórios , Dexmedetomidina , Anestésicos Inalatórios/farmacologia , Animais , Estudos Cross-Over , Dexmedetomidina/farmacologia , Cães , Frequência Cardíaca/efeitos dos fármacos , Distribuição Aleatória , Remifentanil/farmacologia , Sevoflurano/farmacologia
19.
Biomed Eng Online ; 19(1): 84, 2020 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-33189149

RESUMO

BACKGROUND: The amount of propofol needed to induce loss of responsiveness varied widely among patients, and they usually required less than the initial dose recommended by the drug package inserts. Identifying precisely the moment of loss of responsiveness will determine the amount of propofol each patient needs. Currently, methods to decide the exact moment of loss of responsiveness are based on subjective analysis, and the monitors that use objective methods fail in precision. Based on previous studies, we believe that the blink reflex can be useful to characterize, more objectively, the transition from responsiveness to unresponsiveness. The purpose of this study is to investigate the relation between the electrically evoked blink reflex and the level of sedation/anesthesia measured with an adapted version of the Richmond Agitation-Sedation Scale, during the induction phase of general anesthesia with propofol and remifentanil. Adding the blink reflex to other variables may allow a more objective assessment of the exact moment of loss of responsiveness and a more personalized approach to anesthesia induction. RESULTS: The electromyographic-derived features proved to be good predictors to estimate the different levels of sedation/anesthesia. The results of the multinomial analysis showed a reasonable performance of the model, explaining almost 70% of the adapted Richmond Agitation-Sedation Scale variance. The overall predictive accuracy for the model was 73.6%, suggesting that it is useful to predict loss of responsiveness. CONCLUSIONS: Our developed model was based on the information of the electromyographic-derived features from the blink reflex responses. It was able to predict the drug effect in patients undergoing general anesthesia, which can be helpful for the anesthesiologists to reduce the overwhelming variability observed between patients and avoid many cases of overdosing and associated risks. Despite this, future research is needed to account for variabilities in the clinical response of the patients and with the interactions between propofol and remifentanil. Nevertheless, a method that could allow for an automatic prediction/detection of loss of responsiveness is a step forward for personalized medicine.


Assuntos
Anestesia , Bioestatística , Piscadela/efeitos dos fármacos , Propofol/farmacologia , Remifentanil/farmacologia , Eletromiografia/efeitos dos fármacos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Probabilidade
20.
BMC Anesthesiol ; 20(1): 258, 2020 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028197

RESUMO

BACKGROUND: Balanced anaesthesia with propofol and remifentanil, compared to sufentanil, often decreases mean arterial pressure (MAP), heart rate (HR) and cardiac index (CI), raising concerns on tissue-oxygenation. This distinct haemodynamic suppression might be attenuated by atropine. This double blinded RCT, investigates if induction with propofol-sufentanil results in higher CI and tissue-oxygenation than with propofol-remifentanil and if atropine has more pronounced beneficial effects on CI and tissue-oxygenation in a remifentanil-based anaesthesia. METHODS: In seventy patients scheduled for coronary bypass grafting (CABG), anaesthesia was induced and maintained with propofol target controlled infusion (TCI) with a target effect-site concentration (Cet) of 2.0 µg ml- 1 and either sufentanil (TCI Cet 0.48 ng ml- 1) or remifentanil (TCI Cet 8 ng ml- 1). If HR dropped below 60 bpm, methylatropine (1 mg) was administered intravenously. Relative changes (∆) in MAP, HR, stroke volume (SV), CI and cerebral (SctO2) and peripheral (SptO2) tissue-oxygenation during induction of anaesthesia and after atropine administration were analysed. RESULTS: The sufentanil group compared to the remifentanil group showed significantly less decrease in MAP (∆ = - 23 ± 13 vs. -36 ± 13 mmHg), HR (∆ = - 5 ± 7 vs. -10 ± 10 bpm), SV (∆ = - 23 ± 18 vs. -35 ± 19 ml) and CI (∆ = - 0.8 (- 1.5 to - 0.5) vs. -1.5 (- 2.0 to - 1.1) l min- 1 m- 2), while SctO2 (∆ = 9 ± 5 vs. 6 ± 4%) showed more increase with no difference in ∆SptO2 (∆ = 8 ± 7 vs. 8 ± 8%). Atropine caused higher ∆HR (13 (9 to 19) vs. 10 ± 6 bpm) and ∆CI (0.4 ± 0.4 vs. 0.2 ± 0.3 l min- 1 m- 2) in sufentanil vs. remifentanil-based anaesthesia, with no difference in ∆MAP, ∆SV and ∆SctO2 and ∆SptO2. CONCLUSION: Induction of anaesthesia with propofol and sufentanil results in improved haemodynamic stability and higher SctO2 compared to propofol and remifentanil in patients having CABG. Administration of atropine might be useful to counteract or prevent the haemodynamic suppression associated with these opioids. TRIAL REGISTRATION: Clinicaltrials.gov on June 7, 2013 (trial ID: NCT01871935 ).


Assuntos
Anestesia , Encéfalo/metabolismo , Hemodinâmica/efeitos dos fármacos , Oxigênio/metabolismo , Remifentanil/farmacologia , Sufentanil/farmacologia , Idoso , Atropina/farmacologia , Ponte de Artéria Coronária , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
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