Remifentanil versus Morphine Analgesia and Sedation for Mechanically Ventilated Critically Ill Patients: A Randomized Double Blind Study

@article{Dahaba2004RemifentanilVM,
  title={Remifentanil versus Morphine Analgesia and Sedation for Mechanically Ventilated Critically Ill Patients: A Randomized Double Blind Study},
  author={Ashraf A. Dahaba and Tanja Grabner and Peter H. Rehak and Werner F. List and Helfried Metzler},
  journal={Anesthesiology},
  year={2004},
  volume={101},
  pages={640-646}
}
Background: The rapid onset and offset of action of remifentanil could make it quickly adjustable to the required level of sedation in critically ill patients. The authors hypothesized that the efficacy of a remifentanil-based regimen was greater than that of a morphine-based regimen. Methods: Forty intent-to-treat patients were randomly allocated to receive a blinded infusion of either remifentanil 0.15 &mgr;g·kg−1·min−1 or morphine 0.75 &mgr;g·kg−1·min−1. The opioid infusion was titrated, in… 
Sedation in the intensive care unit with remifentanil/propofol versus midazolam/fentanyl: a randomised, open-label, pharmacoeconomic trial
TLDR
Compared with midazolam/fentanyl, a remifentanil-based regimen for analgesia and sedation supplemented with propofol significantly reduced the time on mechanical ventilation and allowed earlier discharge from the ICU, at equal overall costs.
Remifentanil/midazolam versus fentanyl/midazolam for analgesia and sedation of mechanically ventilated neonates and young infants: a randomized controlled trial
TLDR
As neonates and young infants have a decreased metabolism of common opioids like fentanyl and are more prone to respiratory depression, remifentanil could be the ideal opioid for analgesia and sedation of mechanically ventilated infants.
Decreased duration of mechanical ventilation when comparing analgesia-based sedation using remifentanil with standard hypnotic-based sedation for up to 10 days in intensive care unit patients: a randomised trial [ISRCTN47583497]
TLDR
Analgesia-based sedation with remifentanil was well tolerated; it reduces the duration of mechanical ventilation and improves the weaning process compared with standard hypnotic- based sedation regimes in ICU patients requiring long-term ventilation for up to 10 days.
COMPARISON OF SEDATIVE AND HEMODYNAMIC EFFECTS OF REMIFENTANIL AND PROPOFOL IN PATIENTS WITH PULMONARY DISEASE REQUIRING MECHANICAL VENTILATION IN INTENSIVE CARE UNIT
TLDR
Both remifentanil and propofol are suitable drugs for sedating patients with pulmonary disease and neither of them induces dramatic hemodynamic changes, therefore, using each of them is effective for optimal sedation of patients.
A prospective, randomized, double-blind, multicenter study comparing remifentanil with fentanyl in mechanically ventilated patients
TLDR
The use of remifentanil- based analgesia in critically ill patients was not superior regarding the achievement and maintenance of sufficient analgesia compared with fentanyl-based analgesia, and the trial was stopped.
Low-Dose Remifentanil Infusion during Ventilator Weaning and Tracheal Extubation in Postoperative Intensive Care Unit Patients Sedated with Propofol-Remifentanil: A Randomised Clinical Trial
TLDR
Maintaining a low-dose remifentanil infusion during ventilator weaning delayed tracheal extubation without any differences in haemodynamic changes or coughing in postoperative intensive care unit patients.
[Remifentanil-propofol versus fentanyl-midazolam combinations for intracranial surgery: influence of anaesthesia technique and intensive sedation on ventilation times and duration of stay in the ICU].
TLDR
It is demonstrated that remifentanil-propofol anaesthesia and ICU sedation are superior to the combination of fentanyl and midazolam in terms of ventilation time and length of ICU stay.
Remifentanil : a review of its analgesic and sedative use in the intensive care unit.
TLDR
Remifentanil is at least as effective in providing pain relief and sedation in mechanically ventilated ICU patients and allows fast and predictable extubation, as well as being associated with a shorter duration of mechanical ventilation and quicker ICU discharge than comparators in some studies.
Comparison of Hemodynamic Effects of Morphine and Remifentanil in Traumatized Patients Requiring Mechanical Ventilation
TLDR
Remifentanil causes an initial decline in blood pressure but it maintains the pressure in a rather steady state during the period of infusion, quite similar to that of morphine with the additional fact that there was no profound decline of blood pressure with morphine.
A comparison of hypnotic and analgesic based sedation in a general intensive care unit.
TLDR
The use of ABS allowed patients to be managed more comfortably, either without a hypnotic drug or with less hypnoticDrug, than using conventional HBS.
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References

SHOWING 1-10 OF 22 REFERENCES
A low-dose remifentanil infusion is well tolerated for sedation in mechanically ventilated, critically-ill patients
TLDR
Low doses of remifentanil can be useful in critically-ill patients in order to achieve calm and sedation and can inhibit respiratory drive and require controlled mechanical ventilation.
A comparison of the remifentanil and fentanyl adverse effect profile in a multicenter phase IV study.
TLDR
In the doses used, both remifentanil and fentanyl have a similar frequency of adverse effects except for the higher frequency of hypotension associated with the use of remifents, which was associated with more intraoperative hypotension than fentanyl.
Recovery after remifentanil and sufentanil for analgesia and sedation of mechanically ventilated patients after trauma or major surgery.
TLDR
Remifentanil facilitates rapid emergence from analgesia and sedation, allowing a clinical neurological examination within 10-30 min in mechanically ventilated patients with no intracranial pathology.
A Multicenter Evaluation of Remifentanil for Early Postoperative Analgesia
TLDR
There was a large variation in the incidence of respiratory depression between the centers, ranging from 0 to 75%.
Lack of rapid development of opioid tolerance during alfentanil and remifentanil infusions for postoperative pain.
TLDR
Patients who self-controlled their analgesic requirements by using target-controlled infusions of alfentanil and remifENTanil for postoperative analgesia provides no evidence of tolerance to opioids.
The Absence of Acute Tolerance During Remifentanil Infusion in Volunteers
TLDR
In conclusion, no development of acute opioid tolerance was observed during constant remifentanil infusion of 3 h in volunteers.
Histamine Concentrations and Hemodynamic Responses After Remifentamil
TLDR
Investigation of hemodynamic responses to 2-30 micro gram/kg remifentanil (escalating doses) injected as a bolus over 1 min during general anesthesia found it associated with a reduction in systolic blood pressure and heart rate and was not associated with alterations in histamine concentration.
Behavioral and physiological effects of remifentanil and alfentanil in healthy volunteers.
TLDR
The notion that the pharmacodynamic effects of remifentanil are extremely short-lived after the drug is no longer administered must be questioned given the findings that psychomotor effects were still apparent 1 h after the infusion was discontinued.
Pharmacokinetics of Remifentanil (GI87084B) and Its Major Metabolite (GI90291) in Patients Undergoing Elective Inpatient Surgery
TLDR
The pharmacokinetics of remifentanil are consistent with its rapid elimination by blood and tissue esterases; its major metabolite is eliminated more slowly but is not likely to make any significant contribution to the total effect because of its much lower potency.
Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients.
TLDR
SAS is both reliable (high interrater agreement) and valid (high correlation with the Harris and Ramsay scales) in assessing agitation and sedation in adult ICU patients.
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