TY - JOUR
T1 - The safety and effectiveness of remifentanil as an adjunct sedative for regional anesthesia
AU - Lauwers, Marylin
AU - Camu, Frederic
AU - Breivik, Harald
AU - Hagelberg, Anders
AU - Rosen, Michael
AU - Sneyd, Robert
AU - Horn, Allan
AU - Noronha, Druscilla
AU - Shaikh, Soraya
PY - 1999/1
Y1 - 1999/1
N2 - We assessed the sedative potential of continuous infusions of remifentanil with a validated composite alertness scale in 160 patients (ASA physical status I or II) undergoing hip replacement surgery with spinal block (n = 61) or hand surgery using brachial plexus block (n = 93). They were randomized to receive one of the following initial dose regimens in double- blinded fashion: placebo or 0.04, 0.07, or 0.1 μg ≥ kg-1 · min-1 remifentanil subsequently titrated to effect. Additional midazolam IV was allowed for adequate sedation as required. The combined analysis of both surgery groups revealed a dose-related increase in achievement of sedation level ≥2 within 15 min of the start of the study drug infusion; all remifentanil dose comparisons with placebo reached significance (P < 0.001). The remifentanil 50% effective dose for a composite sedation level ≥2 within 15 min of the start of drug infusion was estimated as 0.043 μg · kg-1 · min-1 (95% confidence interval 0.01, 0.059). The requirement for midazolam decreased with increasing remifentanil dose compared with placebo (P < 0.001). The median time to return to alertness after the end of infusion was 10-12 min in the remifentanil groups and 5 min in the placebo group. Significant incidences of nausea, pruritus, sweating, and respiratory depression were reported during remifentanil infusions compared with placebo. The data suggest that remifentanil may be useful for supplementation of regional anesthesia, provided that ventilation is carefully monitored. Implications: In this dose-finding, placebo-controlled study, remifentanil infusions were used to provide sedation during spinal and brachial plexus regional anesthesia. The 50% effective dose for achievement of sedation was 0.043 μg · kg-1 · min-1. Return to alertness occurred after 10-12 min (median time). Remifentanil infusions can be used to supplement regional anesthesia, but this requires careful monitoring of ventilation.
AB - We assessed the sedative potential of continuous infusions of remifentanil with a validated composite alertness scale in 160 patients (ASA physical status I or II) undergoing hip replacement surgery with spinal block (n = 61) or hand surgery using brachial plexus block (n = 93). They were randomized to receive one of the following initial dose regimens in double- blinded fashion: placebo or 0.04, 0.07, or 0.1 μg ≥ kg-1 · min-1 remifentanil subsequently titrated to effect. Additional midazolam IV was allowed for adequate sedation as required. The combined analysis of both surgery groups revealed a dose-related increase in achievement of sedation level ≥2 within 15 min of the start of the study drug infusion; all remifentanil dose comparisons with placebo reached significance (P < 0.001). The remifentanil 50% effective dose for a composite sedation level ≥2 within 15 min of the start of drug infusion was estimated as 0.043 μg · kg-1 · min-1 (95% confidence interval 0.01, 0.059). The requirement for midazolam decreased with increasing remifentanil dose compared with placebo (P < 0.001). The median time to return to alertness after the end of infusion was 10-12 min in the remifentanil groups and 5 min in the placebo group. Significant incidences of nausea, pruritus, sweating, and respiratory depression were reported during remifentanil infusions compared with placebo. The data suggest that remifentanil may be useful for supplementation of regional anesthesia, provided that ventilation is carefully monitored. Implications: In this dose-finding, placebo-controlled study, remifentanil infusions were used to provide sedation during spinal and brachial plexus regional anesthesia. The 50% effective dose for achievement of sedation was 0.043 μg · kg-1 · min-1. Return to alertness occurred after 10-12 min (median time). Remifentanil infusions can be used to supplement regional anesthesia, but this requires careful monitoring of ventilation.
UR - http://www.scopus.com/inward/record.url?scp=0032924615&partnerID=8YFLogxK
U2 - 10.1097/00000539-199901000-00025
DO - 10.1097/00000539-199901000-00025
M3 - Article
C2 - 9895080
AN - SCOPUS:0032924615
SN - 0003-2999
VL - 88
SP - 134
EP - 140
JO - Anesthesia and Analgesia
JF - Anesthesia and Analgesia
IS - 1
ER -