Weaning from mechanical ventilation using remifentanil versus midazolam–morphine analgo sedation: our experience

Introduction

Remifentanil is a short-acting μ-opioid with a half-life of less than 9–10 min, metabolized by plasmatic esterasis. In this retrospective study, we evaluated the safety of remifentanil sedation (RS) versus midazolam–morphine sedation (MM) in 80 patients undergoing abdominal surgery. Our target was to assess whether RS is able to reduce times of weaning from mechanical ventilation with respect to MM sedation.

Methods

Eighty patients treated either with RS or MM were enrolled in two groups. Remifentanil infusion started at dose of 6 μg/kg/hour and titrated to reach Ramsay Sedation Scale 3–5 without the help of other drugs; supplemental midazolam bolus was administered if the patients were still agitated, instead MM was administered at the dosage of 0.01 mg/kg/hour for morphine and 0.03 mg/kg/hour for midazolam, to reach the same Ramsay Sedation Scale. The time of mechanical ventilation, weaning and adverse events (bradycardia, hypotension) were recorded in each patient during treatment and for 3 days after extubation.

Results

Times of mechanical ventilation were the same in the two groups (94.68 ± 30.24 vs 91.04 ± 31.23, P > 0.05). Weaning time is significantly lower using RS than MM (31.15 ± 25.45 vs 39.51 ± 25, P < 0.05) Adverse effects were instead a little bit greater in the RS group than in the MM group (20% vs 12.5%).

Conclusion

Remifentanil is well tolerated by the patients even when used for long periods in the ICU with few adverse μ-opioid effects compared with classical hypnotic-based sedation. Furthermore, remifentanil seems to decrease the time of weaning.