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  • Poster presentation
  • Open Access

Remifentanil-based analgesia and sedation facilitates more rapid and predictable time to neurological assessments

  • 1,
  • 2,
  • 3,
  • 4,
  • 5,
  • 6 and
  • 7
Critical Care20048 (Suppl 1) :P236

https://doi.org/10.1186/cc2703

  • Published:

Keywords

  • Morphine
  • Fentanyl
  • Remifentanil
  • Neurological Function
  • Remi

Introduction

Predictable pharmacokinetics and organ-independent elimination allows remifentanil hydrochloride (Remi) to be easily titrated to provide optimal analgesia with rapid dissipation of effects even after prolonged infusions in critically ill patients. Remi-based analgesia and sedation supplemented with propofol (P) or midazolam (Mid) was compared with a hypnotic-based technique using fentanyl (Fent) or morphine (Morph) in combination with P or Mid for up to 5 days in 161 mechanically ventilated neurotrauma patients.

Methods

Open-label treatment with Remi, Fent or Morph was randomised 2:1:1. Remi infusion was started at 9 μg/kg/hour and titrated to effect. Supplemental P (days 1–3) or Mid (days 4–5) was introduced at a Remi infusion rate of 18 μg/kg/hour to provide optimal sedation (SAS 1–3) and analgesia (none/mild pain). Fent or Morph were administered with P or Mid according to routine practice. Study drugs were reduced/stopped for daily scheduled assessments of neurological function.

Results

From an observed case analysis (on log-transformed data), the overall mean neurological assessment time (unpaired t test) and between-subject variability (F test) around the assessment time were significantly reduced in the Remi group compared with Fent and Morph. Table 1 presents the median (range) time from reducing analgesia/sedation until neurological assessment (hours).

Table 1

 

Overall

Day 1

Day 2

Day 3

Day 4

Day 5

Remi (n = 84)

0.5 (0.2–1.6)

0.4 (0.1–0.9)

0.5 (0.1–1.6)

0.7 (0–3.8)

0.8 (0.3–1.3)

1.0 (0.3–1.8)

Fent (n = 37)

0.7*(0.2–4.6)

0.7*(0.2–4.7)

0.9 (0–4.6)

1.0 (0.2–2.2)

1.8 (0.9–2.4)

1.8*(1.3–2.8)

Morph (n = 40)

1.0*(0.1–4.8)

0.9*(0.1–4.6)

0.7 (0.1–5.3)

1.2 (0.3–2.6)

1.3 (0.9–1.8)

1.9 (1.7–2.1)

*P < 0.05.

Conclusion

The time to assessment of neurological function can be achieved significantly faster and more predictably when using remifentanil-based analgesia and sedation.

Authors’ Affiliations

(1)
Genimatas General Hospital, Athens, Greece
(2)
Red Cross General Hospital of Athens, Greece
(3)
General Hospital of Nikaia, Piraeus, Greece
(4)
Koutlibanio General Hospital of Larisa, Greece
(5)
Martin-Luther-Universitat, Halle, Germany
(6)
St Elizabeth Ziekenhuis, Tilburg, The Netherlands
(7)
GlaxoSmithKline, Greenford, UK

Copyright

© BioMed Central Ltd. 2004

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