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Remifentanil sedation intensive care extubation

Gillian M Keating
Dexmedetomidine (Dexdor(®)) is a highly selective α2-adrenoceptor agonist. It has sedative, analgesic and opioid-sparing effects and is suitable for short- and longer-term sedation in an intensive care setting. In the randomized, double-blind, multicentre MIDEX and PRODEX trials, longer-term sedation with dexmedetomidine was noninferior to midazolam and propofol in terms of time spent at the target sedation range, as well as being associated with a shorter time to extubation than midazolam or propofol, and a shorter duration of mechanical ventilation than midazolam...
July 2015: Drugs
Christian Dualé, Hugues Julien, Bruno Pereira, Bertrand Abbal, Charlotte Baud, Pierre Schoeffler
STUDY OBJECTIVE: To investigate whether pupil diameter (PD) measured during scotopic conditions is influenced by pain in conscious patients in the early postoperative period. DESIGN: Prospective, observational, cohort study. SETTING: Single-center, postanesthesia care unit (PACU). PATIENTS: Patients scheduled for a surgery during general anesthesia. INTERVENTIONS: Baseline PD was measured the day before surgery...
February 2015: Journal of Clinical Anesthesia
Jae Bum Park, Seung Ho Bang, Hyun Keun Chee, Jun Seok Kim, Song Am Lee, Je Kyoun Shin
BACKGROUND: Delirium after cardiac surgery is associated with serious long-term negative outcomes and high costs. The aim of this study is to evaluate neurobehavioral, hemodynamic, and sedative characteristics of dexmedetomidine, compared with the current postoperative sedative protocol (remifentanil) in patients undergoing open heart surgery with cardiopulmonary bypass (CPB). METHODS: One hundred and forty two eligible patients who underwent cardiac surgery on CPB between April 2012 and March 2013 were randomly divided into two groups...
June 2014: Korean Journal of Thoracic and Cardiovascular Surgery
Daniela Avino, Wei-Hong Zhang, Andrée De Villé, Anne-Britt Johansson
OBJECTIVE: To compare remifentanil and morphine-midazolam for use in nonurgent endotracheal intubation in neonates. STUDY DESIGN: In this prospective noninferiority randomized trial, newborns of gestational age ≥28 weeks admitted in the neonatal intensive care unit requiring an elective or semielective endotracheal intubation were divided into 2 groups. One group (n = 36) received remifentanil (1 μg/kg), and the other group (n = 35) received morphine (100 μg/kg) and midazolam (50 μg/kg) at a predefined time before intubation (different in each group), to optimize the peak effect of each drug...
May 2014: Journal of Pediatrics
Lars Welzing, Florian Link, Shino Junghaenel, Andre Oberthuer, Urs Harnischmacher, Hartmut Stuetzer, Bernhard Roth
BACKGROUND: Short-acting opioids like remifentanil are suspected of an increased risk for tolerance, withdrawal and opioid-induced hyperalgesia (OIH). These potential adverse effects have never been investigated in neonates. OBJECTIVES: To compare remifentanil and fentanyl concerning the incidence of tolerance, withdrawal and OIH. METHODS: 23 mechanically ventilated infants received up to 96 h either a remifentanil- or fentanyl-based analgesia and sedation regimen with low-dose midazolam...
2013: Neonatology
Eddie Maraboto
When the clinical picture of a patient in the intensive care unit necessitates placement of an artificial airway supported by mechanical ventilation, a regimen of sedation and analgesia is initiated with the goal of providing anxiolysis and pain control to facilitate ventilation and therapeutic and diagnostic intervention. However, some of the most commonly used sedative agents, such as benzodiazepines, may have profound long-term effects on patients' health, including neuropsychological functioning. With more patients now surviving intensive care, more patients are suffering from these negative health consequences...
April 2013: Critical Care Nursing Quarterly
Ibrahim Abu-Kishk, Eran Kozer, Roei Hod-Feins, Yoram Anekstein, Yigal Mirovsky, Baruch Klin, Gideon Eshel
BACKGROUND: It is common practice for patients to be admitted to the intensive care unit following scoliosis surgery, because of the prolonged anesthesia, the need for efficient pain control and the known immediate postoperative complications. However, this may be unnecessary in many patients. PURPOSE: We aimed to establish possible associations between pre- and perioperative parameters and early postoperative complication rates, in particular the need for prolonged mechanical ventilation (>1 day), and the presence of major complications in children undergoing primary spinal fusion by thoracolumbar spine instrumentation...
March 2013: Paediatric Anaesthesia
S Y Kim, S Y Yang, S W Na, Y Y Jo, S O Koh
Discontinuation of sedatives for ventilator weaning and extubation can be associated with hyperdynamic responses, including hypertension and tachycardia. We examined the effects of a maintained low dose of remifentanil infusion on cardiovascular responses and coughing during extubation in postoperative intensive care unit patients sedated with propofol-remifentanil. Fifty patients who required mechanical ventilation after major abdominal surgery were randomised into remifentanil group (n=25) or control group (n=25)...
July 2012: Anaesthesia and Intensive Care
C J Prieto Vera, E del Cojo Peces, J P Macías Pingarrón, A Asencio Moreno, B Andújar Quirós, I Gragera Collado
OBJECTIVE: To assess the safety and efficacy of using the Anesthetic Conserving Device (AnaConDa) when maintaining sedation after cardiac surgery. MATERIAL AND METHODS: Descriptive study of 46 consecutive patients in the postoperative recovery unit after cardiac surgery between January and April 2009. The patients were under sevoflurane sedation administered with the AnaConDa placed in the inhalation tube. No exclusion criteria were established before enrollment...
August 2011: Revista Española de Anestesiología y Reanimación
Malcie Mesnil, Xavier Capdevila, Sophie Bringuier, Pierre-Olivier Trine, Yoan Falquet, Jonathan Charbit, Jean-Paul Roustan, Gerald Chanques, Samir Jaber
PURPOSE: To evaluate efficacy and adverse events related to inhaled sevoflurane for long-term sedation compared with standard intravenous (i.v.) sedation with propofol or midazolam. METHODS: Randomized controlled trial. Sixty intensive care unit (ICU) patients expected to require more than 24 h sedation were randomly assigned to one of three groups: group S, inhaled sevoflurane; group P, i.v. propofol; group M, i.v. midazolam. All patients also received i.v. remifentanil for goal-directed sedation (Ramsay scale and pain score) until extubation or for a maximum of 96 h...
June 2011: Intensive Care Medicine
Laura Ruggeri, Giovanni Landoni, Fabio Guarracino, Sabino Scolletta, Elena Bignami, Alberto Zangrillo
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...
January 2011: Annals of Cardiac Anaesthesia
Lars Welzing, Anne Vierzig, Shino Junghaenel, Frank Eifinger, Andre Oberthuer, Uwe Trieschmann, Bernhard Roth
Mechanically ventilated pediatric intensive care patients usually receive an analgesic and sedative to keep them comfortable and safe. However, common drugs like fentanyl and midazolam have a long context sensitive half time, resulting in prolonged sedation and an unpredictable extubation time. Children often awake slowly and struggle against the respirator, although their respiratory drive and their airway reflexes are not yet sufficient for extubation. In this pilot study, we replaced fentanyl and midazolam at the final phase of the weaning process with remifentanil and propofol...
April 2011: European Journal of Pediatrics
Tomohiro Suhara, Kiyoshi Moriyama, Yuki Hosokawa, Kimiaki Ai, Junzo Takeda
A 48-year-old woman was diagnosed with cavernous hemangioma of hypopharynx and larynx, which extended to the trachea and mediastinum. She was scheduled for tracheostomy and open surgical excision of hypopharynx hemangioma under general anesthesia. On induction of anesthesia, we planned awake fiberoptic intubation according to the difficult airway algorithm of the American Society of Anesthesiologists. Under continuous infusion of remifentanil at 0.1-0.2 microg x kg(-1) x min(-1), the patient became sedated while spontaneously breathing, and her pain and laryngeal reflexes were reduced...
May 2010: Masui. the Japanese Journal of Anesthesiology
Ingrid Egerod, Malene Brorsen Jensen, Suzanne Forsyth Herling, Karen-Lise Welling
INTRODUCTION: Sedation protocols are needed for neurointensive patients. The aim of this pilot study was to describe sedation practice at a neurointensive care unit and to assess the feasibility and efficacy of a new sedation protocol. The primary outcomes were a shift from sedation-based to analgesia-based sedation and improved pain management. The secondary outcomes were a reduction in unplanned extubations and duration of sedation. METHODS: This was a two-phase (before-after), prospective controlled study at a university-affiliated, 14-bed neurointensive care unit in Denmark...
2010: Critical Care: the Official Journal of the Critical Care Forum
Taiga Itagaki, Sakiko Uchisaki, Yushi Adachi, Katsumi Suzuki, Yukako Obata, Matsuyuki Doi, Shigehito Sato
Dexmedetomidine (DEX) is widely used in intensive care unit for perioperative sedation. The one advantage of DEX administration for sedation is the lack of significant respiratory depression. However, DEX shows significant interaction with anesthetics and narcotics, and we present a case in which post-anesthetic administration of DEX induced apnea and severe respiratory depression after extubation. A 74-year-old, 38.3 kg, 148 cm woman was scheduled to undergo implantation of internal cardiac defibrillator. General anesthesia was maintained by sevoflurane, remifentanil and intermittent administration of fentanyl...
December 2009: Masui. the Japanese Journal of Anesthesiology
Spyros A Papiris, Effrosyni D Manali, Likurgos Kolilekas, Christina Triantafillidou, Iraklis Tsangaris
The precise definition of a severe asthmatic exacerbation is an issue that presents difficulties. The term 'status asthmaticus' relates severity to outcome and has been used to define a severe asthmatic exacerbation that does not respond to and/or perilously delays the repetitive or continuous administration of short-acting inhaled beta(2)-adrenergic receptor agonists (SABA) in the emergency setting. However, a number of limitations exist concerning the quantification of unresponsiveness. Therefore, the term 'acute severe asthma' is widely used, relating severity mostly to a combination of the presenting signs and symptoms and the severity of the cardiorespiratory abnormalities observed, although it is well known that presentation does not foretell outcome...
2009: Drugs
J A Tan, K M Ho
This meta-analysis examined the benefits of using remifentanil as a sedative agent in critically ill patients. A total of 11 randomised controlled trials, comparing remifentanil with another opioid or hypnotic agent in 1067 critically ill adult patients, were identified from the Cochrane controlled trials register and EMBASE and MEDLINE databases, and subjected to meta-analysis. Remifentanil was associated with a reduction in the time to tracheal extubation after cessation of sedation (weighted-mean-difference -2...
December 2009: Anaesthesia
Carmen Giannantonio, Maria Sammartino, Elisabetta Valente, Francesco Cota, Maria Fioretti, Patrizia Papacci
AIM: To assess efficacy of remifentanil in preterm newborns during mechanical ventilation. METHODS: Remifentanil was administered by continuous intravenous infusion to provide analgesia and sedation in 48 preterm infants who developed respiratory distress and required mechanical ventilation. We examined the doses needed to provide adequate analgesia, extubation time after the discontinuation of opioid infusion, the presence of side effects and safety of the use...
July 2009: Acta Paediatrica
L Muller, G Chanques, C Bourgaux, G Louart, S Jaber, P Fabbro-Peray, J Ripart, J-E de La Coussaye, J-Y Lefrant
AIM: Inappropriate sedation could prolong the duration of mechanical ventilation. The present "before-after" study assessed the impact of a goal-directed sedation using an algorithm with a combination of propofol and remifentanil on the time to extubation. METHODS: During 16 months, ICU-patients requiring sedation greater than 24 h were prospectively studied. In the first eight months, sedation was achieved using continuous infusions of a benzodiazepine (flunitrazepam or midazolam) and an opioid (fentanyl or sufentanil)...
June 2008: Annales Françaises D'anesthèsie et de Rèanimation
Wolfram Wilhelm, Sascha Kreuer
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...
2008: Critical Care: the Official Journal of the Critical Care Forum
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