title: A multicenter evaluation of remifentanil for early postoperative analgesia.
abstract: We evaluated the use of an infusion of remifentanil to provide postoperative analgesia during recovery from total intravenous anesthesia (TIVA) with remifentanil and propofol. One hundred fifty-seven patients from seven medical centers underwent abdominal, spine, joint replacement, or thoracic surgery. Remifentanil was titrated in an effort to limit pain to 0 or 1 on a 0-3 scale. At the end of the 30-min titration period, 78% of infusion rates were in the range of 0.05 to < or = 0.15 microgram.kg-1.min-1, 5% were < 0.05 microgram.kg-1.min-1, and 17% were > 0.15 microgram.kg-1.min-1. Pain scores were 0 or 1 in 64% of patients. Nausea occurred in 35% and emesis in 8% of patients; the peak incidence of nausea followed discontinuation of the remifentanil infusion at the time of administering morphine. Respiratory adverse events (oxygen saturation by pulse oximetry [Spo2] < 90% or respiratory rate < 12) affected 29% of patients. Apnea occurred in 11 patients (7.0%). There was a large variation in the incidence of respiratory depression between the centers, ranging from 0 to 75%. The explanation for the large variability in respiratory outcome was not evident.
authors.affiliation: Department of Anesthesiology, University of Washington, Seattle 98195, USA.
authors.forename: T A
authors.initials: TA
authors.lastname: Bowdle
authors.forename: E M
authors.initials: EM
authors.lastname: Camporesi
authors.forename: L
authors.initials: L
authors.lastname: Maysick
authors.forename: C W
authors.initials: CW
authors.lastname: Hogue
authors.forename: R V
authors.initials: RV
authors.lastname: Miguel
authors.forename: M
authors.initials: M
authors.lastname: Pitts
authors.forename: J B
authors.initials: JB
authors.lastname: Streisand
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000762:Anesthesia Recovery Period; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001049:Apnea / Q000139:chemically induced; D005260:Female; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D009325:Nausea / Q000139:chemically induced; D010100:Oxygen / Q000097:blood; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015742:Propofol / Q000008:administration & dosage; D000077208:Remifentanil; D012119:Respiration / Q000187:drug effects; D013131:Spine / Q000601:surgery; D013903:Thoracic Surgery; D014839:Vomiting / Q000139:chemically induced
chemical_list: D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D010880:Piperidines; D009020:Morphine; D000077208:Remifentanil; D010100:Oxygen; D015742:Propofol