Remifentanil intensive care

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... 

Wang JY, Winship SM, Thomas SD, Gin T, Russell GN. Induction of anaesthesia in patients with coronary artery disease a comparison between sevoflmane-remifentanil and fentanyl-etomidate Anaesth Intensive Care 199927(4) 363-8. 

Crankshaw DP, Chan C, Leslie K, Bjorksten AR. Remifentanil concentration during target-controlled mfusion of propofol. Anaesth Intensive Care 2002 30(5) 578-83. 

Breen D, Karabinis A, Malbrain M, Morais R, Albrecht S, Jarnvig IL, Parkinson P, Kirkham AJ. 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. Grit Care 2005 9(3) R200-10. 

Penido MG, Garra R, Sammartino M, Pereira E, Silva Y. Remifentanil in neonatal intensive care and anaesthesia practice. Acta Paediatr 2010 99 1454-63. 

Drug withdrawal A withdrawal syndrome has been described after the use of remifenta-nil by infusion in intensive care units [166 ]. Within 10 minutes of withdrawal, patients experienced tachycardia, hypertension, sweating, mydriasis, and myoclonus. These symptoms persisted despite the use of morphine and clonidine and only resolved on readministration of remifentanil. Gradual tapering of remifentanil reduces the incidence of withdrawal symptoms. 

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