Remifentanil Ketamine

Sondekoppam VR, Gandhi K, Batra YK. Etomidate induced agitation during intraoperative sedation. Saudi J Anaesth 2012 6 303-4. Lopez-Alvarez S, Mayo-Moldes M, Zaballos M, Iglesias BG, Blanco-Davila R. Esmolol versus ketamine-remifentanil combination for early postoperative analgesia after laparoscopic cholecystectomy a randomized controlled trial. Can J Anaesth 2012 59 442-8. 

Several drugs are used intravenously, alone or in combination with other drugs, to achieve an anesthetic state (as components of balanced anesthesia) or to sedate patients in intensive care units who must be mechanically ventilated. These drugs include the following (1) barbiturates (thiopental, methohexital) (2) benzodiazepines (midazolam, diazepam) (3) opioid analgesics (morphine, fentanyl, sufentanil, alfentanil, remifentanil) (4) propofol (5) ketamine and (6) miscellaneous drugs (droperidol, etomidate, dexmedetomidine). Figure 25-2 shows the structures of... 

Operationally, anaesthetics can be classified as inhalational or intravenous. The most used compounds of this last group are thiopental, propofol and ketamine recently, new synthetic opioids related to phenylpiperidines (phentanyl and its congeners, sufentanil, alfentanil, remifentanil) are also used. 

Another study in healthy subjects using various experimental pain models found that ketamine antagonised the respiratory depressant effect of remifentanil. Remifentanil alone produced analgesic effects with all pain tests, but ketamine only enhanced the effect of remifentanil on intramuscular electrical stimulation. Acute remifentanil-induced hyperalgesia and tolerance were detected only by the pressure pain test and were not suppressed by ketamine. The combined effects of remifentanil and ketamine probably depend on the type of pain. ... 

Luginbuhl M, Gerber A, Schnider TW, Petersen-Felix S, Arendt-Nielsen L, Curatolo M. Modulation of remifentanil-induced analgesia, hyperalgesia, and tolerance by small-dose ketamine in humans. Anesth Analg (2003) 96, 726-32. 

Panzer O, Moitra V, Sladen RN. Pharmacology of sedative-analgesic agents dex-medetomidine, remifentanil, ketamine, volatile anesthetics, and the role of peripheral mu antagonists. Grit Care Clin 2009 25(3) 451-69. 

Joly V, Richebe P, Guignard B, et al. Remifentanil-induced postoperative hyperalgesia and its prevention with small-dose ketamine. Anesthesiology 2005 103(1) 147-155. 

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