title: Ammonia plasma concentration and prolonged infusion of remifentanil in patients with acute kidney injury.
abstract: BACKGROUND
  Glycine is an excipient of remifentanil and may induce side effects. To investigate glycine and ammonia concentration with the use of remifentanil in Intensive Care Unit patients with acute kidney injury (AKI) defined by a decrease in creatinine clearance above 50%.
  
  
  METHODS
  Prospective open-label cohort study in three surgical Intensive Care Units. Thirty-three patients with AKI and requiring sedation for at least 72 hours. Sedation with remifentanil and midazolam or propofol was adapted every six hours according to ATICE. Glycine and ammonia plasma concentrations were measured at H0 (start of infusion) and every 12 hours during a continuous intravenous 72 hours remifentanil infusion, and 24 hours after the end of the infusion. Clinical and biological glycine or ammonia toxicity were evaluated.
  
  
  RESULTS
  Fifteen patients required continuous veno-venous hemodiafiltration (CVVHDF). Glycine and ammonia plasma concentrations exceeded the normal value respectively for 11 (33%) and 15 (45%) patients before remifentanil infusion (H0). Accumulation of glycine or ammonia was observed neither for patients with or without CVVHDF. For patients without CVVHDF, the plasma ammonia concentration at the end of remifentanil infusion was significantly correlated with the creatinine clearance at H72 (P=0.03) and with the mean rate of remifentanil infusion (P=0.002). No side effect was reported.
  
  
  CONCLUSIONS
  Remifentanil was not associated with an accumulation of glycine or ammonia in patients with AKI. Plasma ammonia concentration was correlated with the mean rate of remifentanil and creatinine clearance. A 72-hours remifentanil infusion appeared safe for sedation of patients with AKI.
authors.affiliation: CHU Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu-HME, Nantes, France.
authors.forename: A
authors.initials: A
authors.lastname: Roquilly
authors.forename: S
authors.initials: S
authors.lastname: Perbet
authors.forename: F
authors.initials: F
authors.lastname: Simonneau
authors.forename: R
authors.initials: R
authors.lastname: Cinotti
authors.forename: V
authors.initials: V
authors.lastname: Sebille
authors.forename: C
authors.initials: C
authors.lastname: Volteau
authors.forename: C
authors.initials: C
authors.lastname: Gratas
authors.forename: R
authors.initials: R
authors.lastname: Minet-Quinard
authors.forename: O
authors.initials: O
authors.lastname: Loutrel
authors.forename: B
authors.initials: B
authors.lastname: Rozec
authors.forename: C
authors.initials: C
authors.lastname: Lejus
authors.forename: J M
authors.initials: JM
authors.lastname: Constantin
authors.forename: K
authors.initials: K
authors.lastname: Asehnoune
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000641:Ammonia / Q000097:blood*; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D005500:Follow-Up Studies; D005998:Glycine / Q000097:blood; D017583:Hemodiafiltration; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects* / Q000493:pharmacokinetics*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000009:adverse effects* / Q000493:pharmacokinetics*; D011446:Prospective Studies; D000077208:Remifentanil
chemical_list: D006993:Hypnotics and Sedatives; D010880:Piperidines; D000641:Ammonia; D000077208:Remifentanil; D005998:Glycine