Sevoflurane Remifentanil

Oh AY, Kim JH, Hwang JW, Do SH, Jeon YT. Incidence of postoperative nausea and vomiting after paediatric strabismus surgery with sevoflurane or remifentanil-sevoflurane. Br J Anaesth 2010 104(6) 756-60. 

Bi SS, Deng CH, Zhou TY, Guan Z, Li L, li HQ, et al. Remifentanil-sevoflurane interaction models of circulatory response to laryngoscopy and circulatory depression. BrJ Anaesth 2013 110 729-40. 

In addition to the medicines mentioned above, a number of opiate- and non-opiate-based analgesics, including COX-2 inhibitors, anaesthetics (e.g. propofol, desflurane, sevoflurane, ropivacaine, levobupivacaine and remifentanil), neuromuscular blockers (e.g. rocuronium bromid, zemuron, cisatracuiium, doxacurium. 

Children (1 year of age and older) - The table below summarizes the recommended doses in pediatric patients, predominantly American Society of Anesthesiologists (ASA) physical status I, II, or III. In pediatric patients, remifentanil was administered with nitrous oxide or nitrous oxide in combination with halothane, sevoflurane, or isoflurane. 

An anxious 5-year-old child with chronic otitis media and a history of poorly controlled asthma presents for placement of ventilating ear tubes. General anesthesia is required for this short elective ambulatory surgery procedure. What preanesthetic medication should be administered Which of the three commonly used anesthetic techniques would you choose to use in this situation (1) inhalational anesthesia with sevoflurane for induction and maintenance in combination with nitrous oxide, (2) intravenous anesthesia with propofol for induction and maintenance of anesthesia in combination with remifentanil, or (3) balanced anesthesia using propofol for induction of anesthesia followed by a combination of sevoflurane and nitrous oxide for maintenance of anesthesia ... 

Recovery is sufficiently rapid with most intravenous drugs to permit their use for short ambulatory (outpatient) surgical procedures. In the case of propofol, recovery times are similar to those seen with sevoflurane and desflurane. Although most intravenous anesthetics lack antinociceptive (analgesic) properties, their potency is adequate for short superficial surgical procedures when combined with nitrous oxide or local anesthetics, or both. Adjunctive use of potent opioids (eg, fentanyl, sufentanil or remifentanil see Chapter 31) contributes to improved cardiovascular stability, enhanced sedation, and perioperative analgesia. However, opioid compounds also enhance the ventilatory depressant effects of the intravenous agents and increase postoperative emesis. Benzodiazepines (eg, midazolam, diazepam) have a slower onset and slower recovery than the barbiturates or propofol and are rarely used for induction of anesthesia. However, preanesthetic administration of benzodiazepines (eg, midazolam) can be used to provide anxiolysis, sedation, and amnesia when used as part of an inhalational, intravenous, or balanced anesthetic technique. 

Mixtures of remifentanil and sevoflurane have been used in two prospective, open, randomized studies (5,6), which showed that adding remifentanil results in a reduced requirement for sevoflurane for maintenance of anesthesia, leading to faster and easier recovery. 

In a prospective randomized comparison of combined sevoflurane plus remifentanil with combined fentanyl plus etomidate for induction of anesthesia in 10 patients with ischemic heart disease, 3 of the 20 patients given sevoflurane plus remifentanil developed severe bradycardia (heart rate less than 40) and one developed asystole, but the difference between the two groups did not reach statistical significance (20). Therefore, in patients with ischemic heart disease remifentanil should be used with caution, and concurrent administration of glycopyr-rolate 0.2 mg is advisable to reduce the incidence of bradycardia, hypotension, or both, without increasing the heart rate. 

The authors postulated that rapid-sequence induction of anesthesia with sevoflurane had blunted sympathetic tone and allowed uncompensated parasympathetic activation by remifentanil. 

Breslin DS, Reid JE, Mirakhur RK, Hayes AH, McBrien ME. Sevoflurane-nitrous oxide anaesthesia supplemented with remifentanil effect on recovery and cognitive function. Anaesthesia 2001 56(2) 114-19. 

Joo HS, Perks WJ, Belo SE. Sevoflurane with remifentanil allows rapid tracheal intubation without neuromuscular blocking agents. Can J Anaesth 2001 48(7) 646-50. 

Kurdi O, Deleuze A, Marret E, Bonnet F. Asystole during anaesthetic induction with remifentanil and sevoflurane. Br J Anaesth 2001 87(6) 943. 

Albertin A, Casati A, Bergonzi P, Fano G, Torri G. Effects of two target-controlled concentrations (1 and 3 ng/ml) of remifentanil on MACg R of sevoflurane. Anesthesiology (2004) 100, 255-9. 

Coltura MJ-J, Van Belle K, Van Hemelrijck JH. Influence of remifentanil (Ultiva, Glaxo Wellcome) and nitrous oxide on sevoflurane (Sevorane, Abbott) requirement during surgery. 2001 Annual Meeting of the American Society of Anesthesiologists, New Orleans USA, 2002. Abstract A-462. 

In a double-blind, multicenter, randomized study in 20 ASA I-III patients aged 18-69 years and scheduled for elective surgery lasting at least 120 minutes, anesthesia was induced with remifentanil and rocuronium and maintained with sevoflurane or propofol remifentanil was used for... 

Chandler JR, Myers D, Mehta D, Whyte E, Groberman MK, Montgomery CJ, et al. Emergence delirium in children a randomized trial to compare total intravenous anesthesia with propofol and remifentanil to irthalational sevoflurane anesthesia. Pediatr Anaesth April 2013 23(4) 309-15. 

Heyse B, Proost JH, Schumacher PM, Bouillon TW, Vereecke HE, Eleveld DJ, et al. Sevoflurane remifentanil interaction comparison of different response surface models. Anesthesiology 2012 116 311-23. 

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