The effects of remifentanil on endotracheal suctioning-induced increases in intracranial pressure in head-injured patients.
In patients with severe traumatic brain injury, bronchotracheal toilet may be accompanied by deleterious variations in intracranial pressure (ICP). To avoid these effects, IV opioids have been proposed. Twenty mechanically-ventilated patients received 3 ascending IV doses of remifentanil: dose 1 (1 microg/kg bolus, 0.25 microg/kg/min infusion); dose 2 (2 microg/kg bolus, 0.5 microg/kg/min infusion); and dose 3: (4 microg/kg bolus, 1 microg/kg/min infusion). Endotracheal suction was performed 20 min after the beginning of infusion to assess coughing. Heart rate, ICP, mean arterial blood pressure (MAP), cerebral perfusion pressure (CPP), middle cerebral artery mean flow velocity (V(MCA)), and bispectral index were monitored throughout the 30-min study period. Twelve, 15, and 19 patients receiving dose 1, 2, and 3, respectively, required vasopressors to maintain CPP >60 mm Hg. Suctioning resulted in coughing in 16, 15, and 5 patients receiving dose 1, 2, and 3, respectively. An increase in ICP, without change in V(MCA), corresponded to the reduction in MAP consistent with the preservation of autoregulation. Remifentanil used as a continuous infusion in head-injured patients is not an effective drug to block responses to suctioning.
Leone
Marc
M
*Intensive Care Unit and Department of Anesthesiology and the †Department of Biostatistics and Epidemiology, Nord Hospital, Marseilles University Hospital System (AP-HM), Marseilles School of Medicine, Marseilles, France.
Albanèse
Jacques
J
Viviand
Xavier
X
Garnier
Franck
F
Bourgoin
Aurelie
A
Barrau
Karine
K
Martin
Claude
C
D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000502:physiology; D003371:Cough / Q000503:physiopathology; D006259:Craniocerebral Trauma / Q000503:physiopathology*; D004305:Dose-Response Relationship, Drug; D004569:Electroencephalography / Q000187:drug effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006706:Homeostasis; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D007427:Intracranial Pressure / Q000187:drug effects* / Q000502:physiology*; D008297:Male; D020768:Middle Cerebral Artery / Q000502:physiology; D010880:Piperidines / Q000494:pharmacology*; D000077208:Remifentanil; D013396:Suction / Q000009:adverse effects*
D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil