El lugar de los opioides de acción breve: con énfasis en remifentanilo
The place for short-acting opioids: special emphasis on remifentanil.
Wilhelm W, Kreuer S.
Department of Anesthesiology and Intensive Care Medicine, Klinikum St,-Marien-Hospital Lünen, 44534 Lünen, Altstadtstrasse, Germany.wolfram.wilhelm@smh-online.de
Crit Care. 2008;12 Suppl 3:S5. Epub 2008 May 14.
Abstract
Pain is among the worst possible experiences for the critically ill. Therefore, nearly all intensive care patients receive some kind of pain relief, and opioids are most frequently administered. Morphine has a number of important adverse effects, including histamine release, pruritus, constipation, and, in particular, accumulation of morphine-6-glucuronide in patients with renal impairment. Hence, it is not an ideal analgesic for use in critically ill patients. Although the synthetic opioids fentanyl, alfentanil, and sufentanil have better profiles, they undergo hepatic metabolism and their continuous infusion also leads to accumulation and prolonged drug effects. Various attempts have been made to limit these adverse effects, including daily interruption of infusion of sedatives and analgesics, intermittent bolus injections rather than continuous infusions, and selection of a ventilatory support pattern that allows more spontaneous ventilation. However, these techniques at best only limit the effects of drug accumulation, but they do not solve the problem. Another type of approach is to use remifentanil in critically ill patients. Remifentanil is metabolized by unspecific blood and tissue esterases and undergoes rapid metabolism, independent of the duration of infusion or any organ insufficiency. There are data indicating that remifentanil can be used for analgesia and sedation in all kinds of adult intensive care unit patients, and that its use will result in rapid and predictable offset of effect. This may permit both a significant reduction in weaning and extubation times, and clear differentiation between over-sedation and brain dysfunction. This article provides an overview of the use of short-acting opioids in the intensive care unit, with special emphasis on remifentanil. It summarizes the currently available study data regarding remifentanil and provides recommendations for clinical use of this agent.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2391266/pdf/cc6152.pdf
Revisión de la eficacia y seguridad de remifentanilo en la prevención y tratramiento del dolor durante y después de cirugía
Review of the efficacy and safety of remifentanil for the prevention and treatment of pain during and after procedures and surgery.
Sivak EL, Davis PJ.
Department of Anesthesiology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Local Reg Anesth. 2010;3:35-43. Epub 2010 Jul 15.
Abstract
Remifentanil is an ultrashort-acting synthetic opioid. It is metabolized by nonspecific tissue and plasma esterases. Remifentanil's metabolism is responsible for its unique pharmacokinetic profile and flat, context-sensitive half-time. Since its introduction into clinical practice, remifentanil has been used for a variety of anesthetic and analgesic applications; however, concerns regarding a potential for rapid induction of tolerance and/or induced hyperalgesia, coupled with an ultrarapid offset of effect, make the drug less than optimal for use in the pharmacologic management of pain.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3417946/pdf/lra-3-035.pdf
Enlaces para artículos sobre remifentanilo en español
ttp://revista.sedolor.es/imprimir.php?archivo=2007_06_03
http://revista.sedolor.es/imprimir.php?archivo=2007_03_04
http://revista.sedolor.es/articulo.php?ID=267
http://revista.sedolor.es/imprimir.php?archivo=2006_07_03
http://revista.sedolor.es/imprimir.php?archivo=2005_03_02
http://revista.sedolor.es/imprimir.php?archivo=2004_08_07
http://www.scielo.org.co/pdf/rca/v35n3/v35n3a05.pdf
http://www.clasa-anestesia.org/revistas/argentina/HTML/ArgEfectos_
Respiratorios_Y_Usos_Del.htm
http://www.anesthesia-analgesia.org/content/suppl/2003/03/24/88.1.134.DC1/8811134.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
The place for short-acting opioids: special emphasis on remifentanil.
Wilhelm W, Kreuer S.
Department of Anesthesiology and Intensive Care Medicine, Klinikum St,-Marien-Hospital Lünen, 44534 Lünen, Altstadtstrasse, Germany.wolfram.wilhelm@smh-online.de
Crit Care. 2008;12 Suppl 3:S5. Epub 2008 May 14.
Abstract
Pain is among the worst possible experiences for the critically ill. Therefore, nearly all intensive care patients receive some kind of pain relief, and opioids are most frequently administered. Morphine has a number of important adverse effects, including histamine release, pruritus, constipation, and, in particular, accumulation of morphine-6-glucuronide in patients with renal impairment. Hence, it is not an ideal analgesic for use in critically ill patients. Although the synthetic opioids fentanyl, alfentanil, and sufentanil have better profiles, they undergo hepatic metabolism and their continuous infusion also leads to accumulation and prolonged drug effects. Various attempts have been made to limit these adverse effects, including daily interruption of infusion of sedatives and analgesics, intermittent bolus injections rather than continuous infusions, and selection of a ventilatory support pattern that allows more spontaneous ventilation. However, these techniques at best only limit the effects of drug accumulation, but they do not solve the problem. Another type of approach is to use remifentanil in critically ill patients. Remifentanil is metabolized by unspecific blood and tissue esterases and undergoes rapid metabolism, independent of the duration of infusion or any organ insufficiency. There are data indicating that remifentanil can be used for analgesia and sedation in all kinds of adult intensive care unit patients, and that its use will result in rapid and predictable offset of effect. This may permit both a significant reduction in weaning and extubation times, and clear differentiation between over-sedation and brain dysfunction. This article provides an overview of the use of short-acting opioids in the intensive care unit, with special emphasis on remifentanil. It summarizes the currently available study data regarding remifentanil and provides recommendations for clinical use of this agent.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2391266/pdf/cc6152.pdf
Revisión de la eficacia y seguridad de remifentanilo en la prevención y tratramiento del dolor durante y después de cirugía
Review of the efficacy and safety of remifentanil for the prevention and treatment of pain during and after procedures and surgery.
Sivak EL, Davis PJ.
Department of Anesthesiology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Local Reg Anesth. 2010;3:35-43. Epub 2010 Jul 15.
Abstract
Remifentanil is an ultrashort-acting synthetic opioid. It is metabolized by nonspecific tissue and plasma esterases. Remifentanil's metabolism is responsible for its unique pharmacokinetic profile and flat, context-sensitive half-time. Since its introduction into clinical practice, remifentanil has been used for a variety of anesthetic and analgesic applications; however, concerns regarding a potential for rapid induction of tolerance and/or induced hyperalgesia, coupled with an ultrarapid offset of effect, make the drug less than optimal for use in the pharmacologic management of pain.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3417946/pdf/lra-3-035.pdf
Enlaces para artículos sobre remifentanilo en español
ttp://revista.sedolor.es/imprimir.php?archivo=2007_06_03
http://revista.sedolor.es/imprimir.php?archivo=2007_03_04
http://revista.sedolor.es/articulo.php?ID=267
http://revista.sedolor.es/imprimir.php?archivo=2006_07_03
http://revista.sedolor.es/imprimir.php?archivo=2005_03_02
http://revista.sedolor.es/imprimir.php?archivo=2004_08_07
http://www.scielo.org.co/pdf/rca/v35n3/v35n3a05.pdf
http://www.clasa-anestesia.org/revistas/argentina/HTML/ArgEfectos_
Respiratorios_Y_Usos_Del.htm
http://www.anesthesia-analgesia.org/content/suppl/2003/03/24/88.1.134.DC1/8811134.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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