Effect of remifentanil on intracranial pressure and cerebral blood flow velocity in patients with head trauma.
BACKGROUND
Remifentanil, an ultra-short-acting opioid, is used as an on-top analgesic in head trauma patients during transient painful procedures, e.g. endotracheal suctioning, physiotherapy, on the intensive care unit. However, previous studies have shown that opioids may increase intracranial pressure and decrease cerebral blood flow.


METHODS
The present study investigates the effect of remifentanil on mean arterial blood pressure, intracranial pressure measured with intraparenchymal or epidural probes, and on cerebral blood flow velocity assessed by transcranial Doppler flowmetry in 20 head trauma patients sedated with propofol and sufentanil. Ventilation was adjusted for a target PaCO2 of 4.7-5.1 kPa. After baseline measurements a bolus of remifentanil (0.5 microg x kg(-1) i.v.) was administrated followed by a continuous infusion of remifentanil (0.25 microg x kg(-1) x min(-1) i.v.) for 20 min.


RESULTS
There was no change in mean arterial blood pressure, intracranial pressure, and cerebral blood flow velocity in response to remifentanil infusion over time. Statistical analysis was performed using the Wilcoxon Signed Rank test.


CONCLUSIONS
These data suggest that remifentanil can be used for on-top analgesia in head trauma patients without adverse effects on cerebrovascular haemodynamics, cerebral perfusion pressure or intracranial pressure.
Engelhard
K
K
Klinik für Anaesthesiologie der Technischen Universität München, Klinikum rechts der Isar, Munich, Germany. k.engelhard@lrz.tum.de
Reeker
W
W
Kochs
E
E
Werner
C
C
D000701:Analgesics, Opioid / Q000009:adverse effects / Q000494:pharmacology*; D001783:Blood Flow Velocity / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D001831:Body Temperature / Q000187:drug effects; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D006259:Craniocerebral Trauma / Q000150:complications / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007427:Intracranial Pressure / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010880:Piperidines / Q000009:adverse effects / Q000494:pharmacology*; D000077208:Remifentanil; D018709:Statistics, Nonparametric; D013997:Time Factors
D000701:Analgesics, Opioid; D010880:Piperidines; D000077208:Remifentanil