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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,036

Frequency: Monthly

ISSN 0375-9393

Online ISSN 1827-1596


Minerva Anestesiologica 2001 April;67(4):332-7

SMART 2001 


Rational use of opioids

Mastronardi P., Cafiero T.

From the Department of Surgical Anesthesiological and Emergency Sciences, University ''Federico II'', Naples, Italy

The ­role of anal­ge­sia and seda­tion in inten­sive ­care ­units (ICU) is ancil­lary to oth­er inten­sive ­care strat­e­gies, nev­er­the­less ­they per­mit ­that eve­ry oth­er diag­nos­tic and ther­a­peu­tic pro­ce­dure is safe­ly per­formed by keep­ing the ­patient ­pain-­free, anx­ie­ty-­free and coop­er­a­tive. Com­mon­ly ­used opi­oids in ICU ­include mor­phine, fen­ta­nyl, sufen­ta­nil and remi­fen­ta­nil. The ­choice ­among opi­oid ­drugs ­relies on ­their phar­ma­cok­i­net­ics and ­their phar­am­cod­y­nam­ic ­effects. Car­di­o­vas­cu­lar stabil­ity ­observed ­with fen­ta­nyl and sufen­ta­nil indi­cates ­their use in hemo­dy­nam­i­cal­ly com­pro­mised ­patients. ­Short-act­ing remi­fen­ta­nil ­offers sev­er­al advan­tag­es in ­patients requir­ing pro­longed infu­sions. The ­organ-inde­pen­dent metab­olism of ­this new­er mole­cule may be val­u­able in ­patients ­with mul­ti­ple ­organ fail­ure. The ­main indi­ca­tions for opi­oid anal­ge­sia and seda­tion in ICU ­include: 1) Anx­ie­ty, ­pain and agi­ta­tion: in ­turn, ­they can ­increase car­diac work­load, myo­car­dial oxy­gen con­sump­tion and ­rate of dys­ryth­mi­as; 2) imme­di­ate post­op­er­a­tive peri­od ­after ­major sur­gery; 3) ­short-­term inva­sive pro­ce­dures. Poten­tial advan­tag­es ­offered by opi­oids in the ICU set­ting ­also ­include: a) Car­diac pro­tec­tion: in ani­mal mod­els, it has ­been ­observed ­that del­ta-opi­ate rece­cep­tor stim­u­la­tion con­fers a pre­con­di­tion­ing-­like pro­tec­tive ­effects ­against myo­car­dial ische­mia; b) Neu­ro­pro­tec­tion: ­recent stud­ies sug­gest ­that mu- and kap­pa-opi­ate recep­tors are ­involved in ischem­ic pre­con­di­tion­ing ­against sei­zures in the ­brain. Dur­ing opi­oid ther­a­py in the ICU, ­drug tol­er­ance and with­draw­al symp­toms ­should be antic­i­pat­ed and the ­dose adjust­ed accord­ing­ly.

language: English


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