Remifentanil in neurosurgical patients in the intensive care unit

Introduction

Remifentanil is a rapidly metabolized opioid analgesic that is being increasingly used in critically ill patients [1, 2]. Our purpose was to evaluate the hemodynamic changes of sedated neurosurgery patients in the ICU caused by remifentanil as well as the time elapsed until the wakening in comparison with fentanyl and morphine. Patients received remifentanil for more than 5 days in continuous infusion.

Methods

The study was conducted in the 12-bed ICU of a general hospital. One hundred and fifty patients of both sexes were included in the study. Their mean body weight was 77 kg. Mean duration of the surgical intervention was 180 min. After their admission to the ICU, patients were randomly assigned to three groups. Patients in group A received remifentanil 9–10 μg/kg/hour, in group B fentanyl 0.5–6 μg/kg/hour and in group C they received morphine 0.03–0.15 mg/kg/hour. Every 24 hours, sedation and analgesia were stopped for a neurological examination (Glascow Coma Scale). All patients were sedated with propofol and they remained sedated for 5 days at least. Parameters recorded were cardiac rhythm, mean arterial pressure and time to recovery (judged by spontaneous respiration).

Results

See Table 1 for comparison of hemodynamic parameters between the three groups. Recovery time was much shorter when we compared the remifentanil group with the two other groups (P < 0.001). A statistically significant difference was also observed when we compared group B with group C (P < 0.001).

Table 1

Conclusion

We conclude that remifentanil is safe enough for neurosurgerical patients under sedation in the ICU, and that the weakening time is much shorter for patients receiving this analgesic.