Remifentanil versus morphine analgesia and sedation for mechanically ventilated critically ill patients: a randomized double blind study.
BACKGROUND
The rapid onset and offset of action of remifentanil could make it quickly adjustable to the required level of sedation in critically ill patients. The authors hypothesized that the efficacy of a remifentanil-based regimen was greater than that of a morphine-based regimen.


METHODS
Forty intent-to-treat patients were randomly allocated to receive a blinded infusion of either remifentanil 0.15 microg x kg(-1) x min(-1) or morphine 0.75 microg x kg(-1) x min(-1). The opioid infusion was titrated, in the first intent, to achieve optimal sedation defined as Sedation Agitation scale of 4. A midazolam open-label infusion was started if additional sedation was required.


RESULTS
The mean percentage hours of optimal sedation was significantly longer in the remifentanil group (78.3 +/- 6.2) than in the morphine group (66.5 +/- 8.5). This was achieved with less frequent infusion rate adjustments (0.34 +/- 0.25 changes/h) than in the morphine group (0.42 +/- 0.22 changes/h). The mean duration of mechanical ventilation and extubation time were significantly longer in the morphine group (18.1 +/- 3.4 h, 73 +/- 7 min) than in the remifentanil group (14.1 +/- 2.8 h, 17 +/- 6 min), respectively. Remifentanil mean infusion rate was 0.13 +/- 0.03 microg x kg(-1) x min(-1), whereas morphine mean infusion rate was 0.68 +/- 0.28 microg x kg(-1) x min(-1). More subjects in the morphine group (9 of 20) than in the remifentanil group (6 of 20) required midazolam. The incidence of adverse events was low and comparable across the two treatment groups.


CONCLUSIONS
A remifentanil-based regimen was more effective in the provision of optimal analgesia-sedation than a standard morphine-based regimen. The remifentanil-based regimen allowed a more rapid emergence from sedation and facilitated earlier extubation.
Department of Anaesthesiology and Intensive Care Medicine, Graz University, Austria. ashraf.dahaba@meduni-graz.at
Ashraf A
AA
Dahaba
Tanja
T
Grabner
Peter H
PH
Rehak
Werner F
WF
List
Helfried
H
Metzler
D000328:Adult; D000368:Aged; D000465:Algorithms; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003422:Critical Care / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006993:Hypnotics and Sedatives; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use*; D010147:Pain Measurement / Q000187:drug effects; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D000077208:Remifentanil; D012121:Respiration, Artificial
D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D010880:Piperidines; D009020:Morphine; D000077208:Remifentanil