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Minerva Anestesiologica 2002 October;68(10):765-73

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: Italian

Experience with remifentanil in the ICU

De Bellis P., Gerbi G., Bacigalupo P., Buscaglia G., Massobrio B., Montagnani L., Servidei L.

Servizio Anestesia e Rianimazione, E.O. «Ospedali Galliera», Genova


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Back­ground. Anal­ge­sia and seda­tion are indis­pens­able in ­patients admit­ted to inten­sive ­care for the fol­low­ing, prin­ci­pal rea­sons: to con­trol ­their ­state of anx­ie­ty, ­induce amne­sia, ­improve ­their adap­ta­tion to mechan­i­cal ven­ti­la­tion, ­make inva­sive manoeu­vres tol­er­able. The pur­pose of the ­present ret­ro­spec­tive anal­y­sis is to ­assess the effec­tive­ness of remi­fen­ta­nil in a ­total of 1085 ­patients admit­ted to our Resus­ci­ta­tion and Inten­sive ­Care Depart­ment in 1997-2001.
Meth­ods. A sam­ple of 60 ­adults was tak­en ­from ­these ­patients. The ­group was homo­ge­ne­ous in ­terms of age (67.3±10.2 kg), ­weight (66.7±10.2 kg), dura­tion of seda­tion (6.8±1.6 ­days) and ­index of grav­ity (­SAPS 30.1±4.4). The ­patients ­were suf­fer­ing ­from chron­ic obstruc­tive bron­chop­neu­mop­a­thy, sub­ject­ed to mechan­i­cal ven­ti­la­tion and sedat­ed ­with remi­fen­ta­nil. The sam­ple was ­then com­pared ­with ­another 2 ­groups (homo­ge­ne­ous ­with the ­first) of 20 ­patients ­each, treat­ed ­with pro­pof­ol and mid­az­o­lam as the ­only ­drug. Fol­low­ing an ­initial ­bolus of 2 mg/kg (±0.04) for pro­pof­ol and 0.15 mg/kg (±0.03) for mid­az­o­lam (no ­bolus for remi­fen­ta­nil), the dos­es of sub­se­quent con­tin­u­ous infu­sion (­initial dos­es in the ­case of remi­fen­ta­nil) ­were: 0.05 mcg/kg/m (±0.01) for remi­fen­ta­nil; 1 mg/kg/h (±0.04) for pro­pof­ol; 0.03 mg/kg/h (±0.006) for mid­az­o­lam. In ­order to ­assess the lev­el and qual­ity of seda­tion, 2 sub­jec­tive eval­u­a­tion ­scales (Ram­sey ­score and the Seda­tion-Agi­ta­tion ­Score: SAS) and one ­system of objec­tive eval­u­a­tion (Bispec­tral ­Index; BIS) ­were ­employed. The BIS is a ­direct meas­ure of the ­effects of anaesthet­ics on the ­brain. It is rep­re­sent­ed by a sin­gle dig­it (­between 100, ­state of arou­sal, and ­zero, EEG ­flat), ­derived sta­tis­ti­cal­ly and empir­i­cal­ly ­from the EEG.
­Results. No sig­nif­i­cant dif­fer­enc­es ­were encoun­tered as ­regards qual­ity of seda­tion ­among the 3 ­groups but ­there was a sig­nif­i­cant dif­fer­ence in neg­a­tive car­di­o­vas­cu­lar activ­ity in ­patients treat­ed ­with pro­pof­ol (12% reduc­tion in Cl, 13.8% reduc­tion in SVR). A sig­nif­i­cant accu­mu­la­tion of the ­drug was ­observed in cas­es treat­ed ­with mid­az­o­lam, where­as ­there was no accu­mu­la­tion for remi­fen­ta­nil and pro­pof­ol in rela­tion to the dura­tion of the infu­sion.
Con­clu­sions. Of the var­i­ous seda­tion modal­ities ­employed, we pre­fer the one ­which ­uses remi­fen­ta­nil as the ­sole ­drug ­because a ­good lev­el of seda­tion is ­obtained, ­there is no accu­mu­la­tion, lit­tle inter­fer­ence ­with car­di­o­vas­cu­lar param­e­ters and low­er ­costs in com­par­i­son ­with the oth­ers.

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