Remifentanil en pacientes cardiacos graves |
Remifentanil in critically ill cardiac patients
Laura Ruggeri, Giovanni Landoni, Fabio Guarracino, Sabino Scolletta, Elena Bignami, Alberto Zangrillo
Department of Anesthesia and Intensive Care Medicine, Università Vita-Salute San Raffaele, Milan, Italy. Department of Cardiothoracic, Cardiothoracic Anesthesia and Intensive Care Medicine, University Hospital of Pisa, Pisa, Italy. Department of Surgery and Bioengineering, Unit of Cardiothoracic Anesthesia and Intensive Care, University of Siena, Siena, Italy
Ann of Cardiac Anaesth 2011;14: 6-12. DOI: 10.4103/0971-9784.74393
Remifentanil has a unique pharmacokinetic profile, with a rapid onset and offset of action and a plasmatic metabolism. Its use can be recommended even in patients with renal impairment, hepatic dysfunction or poor cardiovascular function. A potential protective cardiac preconditioning effect has been suggested. Drug-related adverse effects seem to be comparable with other opioids. In cardiac surgery, many randomized controlled trials demonstrated that the potential benefits of the use of remifentanil not only include a profound protection against intraoperative stressful stimuli, but also rapid postoperative recovery, early weaning from mechanical ventilation, and extubation. Remifentanil shows ideal properties of sedative agents being often employed for minimally invasive cardiologic techniques, such as transcatheter aortic valve implantation and radio frequency treatment of atrial flutter, or diagnostic procedures such as transesophageal echocardiography. In intensive care units remifentanil is associated with a reduction in the time to tracheal extubation after cessation of the continuous infusion; other advantages could be more evident in patients with organ dysfunction. Effective and safe analgesia can be provided in case of short and painful procedures (i.e. chest drain removal). In conclusion, thanks to its peculiar properties, remifentanil will probably play a major role in critically ill cardiac patients.
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| Comparación de la efectividad de lidocaína y salbutamol sobre la tos provocada por remifentanil intravenoso durante la inducción de la anestesia |
Comparison of the effectiveness of lidocaine and salbutamol on coughing provoked by intravenous remifentanil during anesthesia induction.
Bang SR, Ahn HJ, Kim HJ, Kim GH, Kim JA, Yang M, Kim JK, Cho HS.
Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital, Inje University School of Medicine, Busan, Korea.
Korean J Anesthesiol. 2010 Nov;59(5):319-22. Epub 2010 Nov 25.
Abstract
BACKGROUND: Coughing is a side effect of opioids that is rarely studied. Here, we evaluated the incidence of remifentanil induced coughing during anesthesia induction in an attempt to identify its risk factors and to examine the preventive effects of lidocaine and salbutamol.
METHODS: A total of 237 patients scheduled to undergo general anesthesia were allocated randomly into three groups. Group C received no medication, while Group L received 2% lidocaine at 0.5 mg/kg intravenously 1 minute prior to remifentanil infusion and Group S inhaled one metered aerosol puff of salbutamol 15 minutes prior to entering the operating room. Remifentanil was infused at 5 ng/ml by target controlled infusion and coughing was measured for five minutes and graded as none, mild, moderate, or severe based on the number of coughs. RESULTS: The incidences of coughing were 30.4%, 25.3%, and 35.4% in Groups C, L, and S, respectively. The incidences, onset times, and severity of coughing did not differ significantly among groups. In addition, multivariate analysis showed that non-smoking and a lower body weight were risk factors of remifentanil-induced coughing (odds ratio, 8.13; P = 0.024, 1.11, and 0.004, respectively). CONCLUSIONS: The incidence of remifentanil-induced coughing was 30%. A total of 0.5 mg/kg lidocaine and 1 metered aerosol puff of salbutamol did not prevent coughing. Non-smoking and low body weight were found to be risk factors of remifentanil-induced coughing.
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