Remifentanil and the brain.
OBJECTIVE
Remifentanil is an ultra-short-acting opioid, increasingly used today in neuroanesthesia and neurointensive care. Its characteristics make remifentanil a potentially ideal agent, but previous data have cast a shadow on this opioid, supporting potentially toxic effects on the ischemic brain. The aim of the present concise review is to survey available up-to-date information on the effects of remifentanil on the central nervous system.


METHODS
A MEDLINE search within the past seven years for available up-to-date information on remifentanil and brain was performed.


RESULTS
Concise up-to-date information on the effects of remifentanil on the central nervous system was reported, with a particular emphasis on the following topics: cerebral metabolism, electroencephalogram, electrocorticography, motor-evoked potentials, regional cerebral blood flow, cerebral blood flow velocity, arterial hypotension and hypertension, intracranial pressure, cerebral perfusion pressure, cerebral autoregulation, cerebrovascular CO(2) reactivity, cerebrospinal fluid, painful stimulation, analgesia and hyperalgesia, neuroprotection, neurotoxicity and hypothermia.


CONCLUSIONS
The knowledge of the influence of remifentanil on brain functions is crucial before routine use in neuroanesthesia to improve anesthesia performance and patient safety as well as outcome.
Fodale
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Department of Neuroscience, Psychiatric and Anesthesiological Sciences, University of Messina, Messina, Italy. vfodale@unime.it
Schifilliti
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Praticò
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Santamaria
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D000701:Analgesics, Opioid / Q000494:pharmacology*; D000758:Anesthesia; D000818:Animals; D001783:Blood Flow Velocity / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D001921:Brain / Q000187:drug effects* / Q000502:physiology; D002245:Carbon Dioxide / Q000097:blood; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D004569:Electroencephalography / Q000187:drug effects; D006801:Humans; D007427:Intracranial Pressure / Q000187:drug effects; D009493:Neurosurgery; D010880:Piperidines / Q000494:pharmacology*; D000077208:Remifentanil
D000701:Analgesics, Opioid; D010880:Piperidines; D002245:Carbon Dioxide; D000077208:Remifentanil