Alternatives to remifentanil for the analgesic component of total intravenous anaesthesia: a narrative review.
Anaesthesia
; 78(5): 620-625, 2023 05.
Article
in En
| MEDLINE
| ID: mdl-36562193
ABSTRACT
Propfol-remifentanil-based total intravenous anaesthesia has dominated recent clinical practice due to its favourable pharmacokinetic profile. Interruption in remifentanil supply has presented an opportunity to diversify or even avoid the use of opioids and consider adjuncts to propofol-based total intravenous anaesthesia. Propofol, while a potent hypnotic, is not an effective analgesic. The administration of opioids, along with other adjuncts such as α-2 adrenoceptor agonists, magnesium, lidocaine, ketamine and nitrous oxide provide surgical anaesthesia and avoids large doses of propofol being required. We provide an overview of both target-control and manual infusion regimes for the alternative opioids alfentanil, sufentanil and fentanyl. The optimal combination of hypnotic-opioid dose, titration sequence and anticipated additional postoperative analgesia required depend on the chosen combination. In addition, we include a brief discussion on the role of non-opioid adjuncts in total intravenous anaesthesia, suggested doses and expected reduction in propofol dose.
Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Propofol
Type of study:
Guideline
Limits:
Humans
Language:
En
Journal:
Anaesthesia
Year:
2023
Document type:
Article
Affiliation country:
Irlanda