Document Detail

Remifentanil infusion does not induce opioid tolerance after cardiac surgery.
MedLine Citation:
PMID:  18375324     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Remifentanil is being used increasingly during fast-track cardiac surgery. Postoperative hyperalgesia and opioid tolerance have been reported in volunteer studies and in patients after major abdominal surgery with remifentanil infusion. In the present study, the authors evaluated whether high-dose remifentanil infusion induces opioid tolerance in 90 patients undergoing coronary artery bypass surgery with sternotomy. DESIGN: Prospective, randomized, and double-blind study. SETTING: Single-institution, tertiary level, university hospital. PARTICIPANTS: Ninety patients undergoing coronary artery bypass surgery. INTERVENTIONS: Patients were randomized to receive a 3-hour infusion of remifentanil (0.3 microg/kg/min, n = 45) or placebo (n = 45) intraoperatively as adjunct to a standardized sufentanil/propofol-based general anesthesia. MEASUREMENTS AND MAIN RESULTS: Opioid consumption, pain, and sedation scores, as well as adverse events and patients' satisfaction with pain therapy, were recorded for 48 postoperative hours. There were no differences in postoperative opioid consumption between the groups (median oxycodone consumption in the remifentanil group, 98 mg [range, 29-166] and in the placebo group, 99 mg [42-219]). Pain scores were comparable at rest, but during a deep breath pain scores were lower in the remifentanil group (p = 0.020). Sedation scores, satisfaction with analgesia, and adverse events were similar between the 2 groups. The most common adverse event was nausea, with a 33% incidence in the placebo and 40% incidence in the remifentanil group. CONCLUSION: Three-hour remifentanil infusion did not increase postoperative pain or opioid consumption in cardiac surgery patients. The present results suggest that high-dose remifentanil does not elicit opioid tolerance when given during cardiac surgery.
Pasi Lahtinen; Hannu Kokki; Markku Hynynen
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2007-10-29
Journal Detail:
Title:  Journal of cardiothoracic and vascular anesthesia     Volume:  22     ISSN:  1532-8422     ISO Abbreviation:  J. Cardiothorac. Vasc. Anesth.     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-03-31     Completed Date:  2008-06-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9110208     Medline TA:  J Cardiothorac Vasc Anesth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  225-9     Citation Subset:  IM    
Department of Anesthesiology and Intensive Care, University of Kuopio, Kuopio, Finland.
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MeSH Terms
Analgesics, Opioid / administration & dosage*
Coronary Artery Bypass* / adverse effects,  methods
Double-Blind Method
Drug Tolerance / physiology*
Infusions, Intravenous
Middle Aged
Pain Measurement / drug effects,  methods
Pain, Postoperative / etiology,  prevention & control
Piperidines / administration & dosage*
Reg. No./Substance:
0/Analgesics, Opioid; 0/Piperidines; 132875-61-7/remifentanil

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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