| Rapid development of tolerance to analgesia during remifentanil infusion in humans. | |
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MedLine Citation:
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PMID: 9620525 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Studies in experimental animals have demonstrated a rapidly developing acute tolerance to the analgesic effect of opioids administered by continuous i.v. infusion. The aim of the present study was to determine whether acute tolerance plays an important role in the analgesic effect of remifentanil provided by i.v. infusion to humans. The analgesic effect of remifentanil, infused at a constant rate of 0.1 microg x kg(-1) x min(-1) for 4 h, was evaluated by measuring pain tolerance with thermal (2 degrees C water) and mechanical (pressure) noxious stimulations in 13 paid volunteers. The constant-rate infusion of remifentanil resulted in a threefold increase in pain tolerance with both tests. After reaching its maximum in 60-90 min, the analgesic effect of remifentanil began to decline despite the constant-rate infusion, and after 3 h of infusion, it was only one fourth of the peak value. A comparative rate in the development of acute tolerance measured in terms of time to 50% recovery during infusion was 129 +/- 27 min (mean +/- SD) with the cold water test and 138 +/- 39 min with the pressure test. We conclude that the development of tolerance should be included in the calculations for target-controlled infusions. Implications: Our study shows that tolerance to analgesia during remifentanil infusion is profound and develops very rapidly. The administration of opioids during anesthesia based on target-controlled infusions should include corrections for the development of tolerance. |
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Authors:
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H R Vinik; I Kissin |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Anesthesia and analgesia Volume: 86 ISSN: 0003-2999 ISO Abbreviation: Anesth. Analg. Publication Date: 1998 Jun |
Date Detail:
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Created Date: 1998-06-19 Completed Date: 1998-06-19 Revised Date: 2008-11-21 |
Medline Journal Info:
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Nlm Unique ID: 1310650 Medline TA: Anesth Analg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1307-11 Citation Subset: AIM; IM |
Affiliation:
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Department of Anesthesiology, University of Alabama at Birmingham, USA. ronald.vinik@ccc.uab.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Analgesia* Analgesics, Opioid / administration & dosage, therapeutic use* Analysis of Variance Cold Temperature / adverse effects Drug Tolerance Female Humans Infusions, Intravenous Least-Squares Analysis Male Pain / prevention & control Pain Threshold / drug effects Piperidines / administration & dosage, therapeutic use* Placebos Pressure / adverse effects Single-Blind Method Time Factors |
| Grant Support | |
ID/Acronym/Agency:
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GM-35135/GM/NIGMS NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Analgesics, Opioid; 0/Piperidines; 0/Placebos; 132875-61-7/remifentanil |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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