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Brenda D Jamerson - One of the best experts on this subject based on the ideXlab platform.
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Remifentanil versus Remifentanil midazolam for ambulatory surgery during monitored anesthesia care
Anesthesiology, 1997Co-Authors: Martin Irwin Gold, Yungfong Sung, Marcia Y Clarke, N. T. Lim Uy, David W Watkins, Joel Yarmush, Walter G. Maurer, Frances Chung, Brenda D JamersonAbstract:Background: This study was designed to define the appropriate dose of Remifentanil hydrochloride alone or combined with midazolam to provide satisfactory comfort and maintain adequate respiration for a monitored anesthesia care setting. Methods : One hundred fifty-nine patients scheduled for outpatient surgery participated in this multicenter, double-blind study. Patients were randomly assigned to one of two groups: Remifentanil, 1 μg/kg, given over 30 s followed by a continuous infusion of 0.1 μg.kg min -1 (Remifentanil); Remifentanil, 0.5 μg/kg, given over 30 s followed by a continuous infusion of 0.05 μg. kg -1 min -1 (Remifentanil + midazolam). Five minutes after the start of the infusion, patients received a loading dose of saline placebo (Remifentanil) or midazolam, 1 mg, (Remifentanil + midazolam). If patients were not oversedated, a second dose of placebo or midazolam, 1 mg, was given. Remifentanil was titrated (in increments of 50% from the initial rate) to limit patient discomfort or pain intraoperatively, and the infusion was terminated at the completion of skin closure. Results: At the time of the local anesthetic, most patients in the Remifentanil and Remifentanil + midazolam groups experienced no pain (66% and 60%, respectively) and no discomfort (66% and 65%, respectively). The final mean (± SD) Remifentanil infusion rates were 0.12 ± 0.05 μg. kg -1 . min -1 (Remifentanil) and 0.07 ± 0.03 μg.kg -1 . min -1 (Remifentanil + midazolam). Fewer patients in the Remifentanil + midazolam group experienced nausea compared with the Remifentanil group (16% vs. 36%, respectively; P < 0.05). Four patients (5%) in the Remifentanil group and two patients (2%) in the Remifentanil + midazolam group experienced brief periods of oxygen desaturation (Sp o2 < 90%) and hypoventilation (< 8 breaths/ min). Conclusions: Remifentanil alone or combined with midazolam provided adequate analgesia and maintained adequate respiration at the doses reported. The low dose of Remifentanil combined with 2 mg midazolam, compared with Remifentanil alone, resulted in fewer side effects, slightly greater sedation, and less anxiety.
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Remifentanil versus Remifentanil/midazolam for Ambulatory Surgery during Monitored Anesthesia Care
Anesthesiology, 1997Co-Authors: Martin Irwin Gold, Yungfong Sung, Marcia Y Clarke, Joel Yarmush, Walter G. Maurer, Frances Chung, W. David Watkins, Brenda D JamersonAbstract:BACKGROUND This study was designed to define the appropriate dose of Remifentanil hydrochloride alone or combined with midazolam to provide satisfactory comfort and maintain adequate respiration for a monitored anesthesia care setting. METHODS One hundred fifty-nine patients scheduled for outpatient surgery participated in this multicenter, double-blind study. Patients were randomly assigned to one of two groups: Remifentanil, 1 microgram/kg, given over 30 s followed by a continuous infusion of 0.1 microgram.kg-1.min-1 (Remifentanil), Remifentanil, 0.5 microgram/kg, given over 30 s followed by a continuous infusion of 0.05 microgram.kg-1.min-1 (Remifentanil+midazolam). Five minutes after the start of the infusion, patients received a loading dose of saline placebo (Remifentanil) or midazolam, 1 mg, (Remifentanil+midazolam). If patients were not oversedated, a second dose of placebo or midazolam, 1 mg, was given. Remifentanil was titrated (in increments of 50% from the initial rate) to limit patient discomfort or pain intraoperatively, and the infusion was terminated at the completion of skin closure. RESULTS At the time of the local anesthetic, most patients in the Remifentanil and Remifentanil+midazolam groups experienced no pain (66% and 60%, respectively) and no discomfort (66% and 65%, respectively). The final mean (+/-SD) Remifentanil infusion rates were 0.12 +/- 0.05 microgram.kg-1.min-1 (Remifentanil) and 0.07 +/- 0.03 microgram.kg-1.min-1 (Remifentanil+midazolam). Fewer patients in the Remifentanil+midazolam group experienced nauses compared with the Remifentanil group (16% vs. 36%, respectively; P < 0.05). Four patients (5%) in the Remifentanil group and two patients (2%) in the Remifentanil+midazolam group experienced brief periods of oxygen desaturation (SpO2 < 90%) and hypoventilation (< 8 breaths/ min). CONCLUSIONS Remifentanil alone or combined with midazolam provided adequate analgesia and maintained adequate respiration at the doses reported. The low dose of Remifentanil combined with 2 mg midazolam, compared with Remifentanil alone, resulted in fewer side effects, slightly greater sedation, and less anxiety.
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Remifentanil compared with alfentanil for ambulatory surgery using total intravenous anesthesia
Anesthesia & Analgesia, 1997Co-Authors: Beverly K Philip, Walter G. Maurer, Frances Chung, Philip E Scuderi, Thomas J Conahan, John J Angel, Surinder K Kallar, Elizabeth P Skinner, Brenda D JamersonAbstract:The purpose of this study was to test the hypothesis that using a 1:4 ratio of Remifentanil to alfentanil, a Remifentanil infusion would provide better suppression of intraoperative responses and comparable recovery profiles after ambulatory laparoscopic surgery than an alfentanil infusion, as part of total intravenous anesthesia. Two hundred ASA physical status I, II, or III adult patients participated in this multicenter, double-blind, parallel group study. Patients were randomly assigned 2:1 to either the Remifentanil-propofol or alfentanil-propofol regimens. The anesthesia sequence was propofol (2 mg/kg intravenously [IV] followed by 150 micrograms.kg-1.min-1), and either Remifentanil (1 microgram/kg IV followed by 0.5 microgram.kg-1.min-1)of alfentanil (20 micrograms/kg IV followed by 2 micrograms.kg-1.min-1), and vecuronium. After trocar insertion, infusion rates were decreased (propofol to 75 micrograms.kg-1.min-1; Remifentanil to 0.25 microgram.kg-1.min-1; alfentanil to 1 microgram.kg-1.min-1). Alfentanil and propofol were discontinued at 10 and 5 min, respectively, before the anticipated end of surgery (last surgical suture); Remifentanil was discontinued at the end of surgery. Recovery times were calculated from the end of surgery. The median duration of surgery was similar between groups (39 min for Remifentanil versus 34 min for alfentanil). A smaller proportion of Remifentanil patients than alfentanil patients had any intraoperative responses (53% vs 71%, P = 0.029), had responses to trocar insertion (11% vs 32%, P < 0.001), or required dosage adjustments during maintenance (24% vs 41%, P < 0.05). Early awakening times were similar. Remifentanil patients qualified for Phase 1 discharge later and were given postoperative analgesics sooner than alfentanil patients (P < 0.05). Actual discharge times from the ambulatory center were similar between groups (174 min for Remifentanil versus 204 min for alfentanil) (P = 0.06). In conclusion, Remifentanil can be used for maintenance of anesthesia in a 1:4 ratio compared with alfentanil, for total IV anesthesia in ambulatory surgery. This dose of Remifentanil provides more effective suppression of intraoperative responses and does not result in prolonged awakening.
Marcel Chauvin - One of the best experts on this subject based on the ideXlab platform.
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Remifentanil induced postoperative hyperalgesia and its prevention with small dose ketamine
Anesthesiology, 2005Co-Authors: Vincent Joly, Philippe Richebe, Bruno Guignard, Dominique Fletcher, P Maurette, Daniel I Sessler, Marcel ChauvinAbstract:Background: Remifentanil-induced secondary hyperalgesia has been documented experimentally in both animals and healthy human volunteers, but never clinically. This study tested the hypotheses that increased pain sensitivity assessed by periincisional allodynia and hyperalgesia can occur after relatively large-dose intraoperative Remifentanil and that smalldose ketamine prevents this hyperalgesia. Methods: Seventy-five patients undergoing major abdominal surgery were randomly assigned to receive (1) intraoperative Remifentanil at 0.05 g kg 1 min 1 (small-dose Remifentanil); (2) intraoperative Remifentanil at 0.40 g kg 1 min 1 (largedose Remifentanil); or (3) intraoperative Remifentanil at 0.40 g kg 1 min 1 and 0.5 mg/kg ketamine just after the induction, followed by an intraoperative infusion of 5 g kg 1 min 1 until skin closure and then 2 g kg 1 min 1 for 48 h (large-dose Remifentanil‐ketamine). Pain scores and morphine consumption were recorded for 48 postoperative hours. Quantitative sensory tests, peak expiratory flow measures, and cognitive tests were performed at 24 and 48 h. Results: Hyperalgesia to von Frey hair stimulation adjacent to the surgical wound and morphine requirements were larger (P < 0.05) and allodynia to von Frey hair stimulation was greater (P < 0.01) in the large-dose Remifentanil group compared with the other two groups, which were comparable. There were no significant differences in pain, pressure pain detection threshold with an algometer, peak flow, cognitive tests, or side effects. Conclusion: A relatively large dose of intraoperative Remifentanil triggers postoperative secondary hyperalgesia. Remifentanil-induced hyperalgesia was prevented by small-dose ketamine, implicating an N-methyl-D-aspartate pain-facilitator process.
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supplementing desflurane Remifentanil anesthesia with small dose ketamine reduces perioperative opioid analgesic requirements
Anesthesia & Analgesia, 2002Co-Authors: Bruno Guignard, Daniel I Sessler, Carole Coste, Helene Costes, C Lebrault, W P Morris, Guy Simonnet, Marcel ChauvinAbstract:UNLABELLED Relative large-dose intraoperative Remifentanil could lead to the need for more postoperative analgesics. Intraoperative N-methyl-D-aspartate receptor antagonists, such as ketamine, decrease postoperative opioid use. We therefore tested the hypothesis that intraoperative small-dose ketamine improves postoperative analgesia after major abdominal surgery with Remifentanil-based anesthesia. Fifty patients undergoing abdominal surgery under Remifentanil-based anesthesia were randomly assigned to intraoperative ketamine or saline (control) supplementation. The initial ketamine dose of 0.15 mg/kg was followed by 2 microg. kg(-1). min(-1). In both groups, desflurane was kept constant at 0.5 minimum alveolar anesthetic concentration without N(2)O, and a Remifentanil infusion was titrated to autonomic responses. All patients were given 0.15 mg/kg of morphine 30 min before the end of surgery. Pain scores and morphine consumption were recorded for 24 postoperative h. Less of the Remifentanil was required in the Ketamine than in the Control group (P < 0.01). Pain scores were significantly larger in the Control group during the first 15 postoperative min but were subsequently similar in the two groups. The Ketamine patients required postoperative morphine later (P < 0.01) and received less morphine during the first 24 postoperative h: 46 mg (interquartile range, 34-58 mg) versus 69 mg (interquartile range, 41-87 mg, P < 0.01). No psychotomimetic symptoms were noted in either group. In conclusion, supplementing Remifentanil-based anesthesia with small-dose ketamine decreases intraoperative Remifentanil use and postoperative morphine consumption without increasing the incidence of side effects. Thus, intraoperative small-dose ketamine may be a useful adjuvant to intraoperative Remifentanil. IMPLICATIONS Supplementing Remifentanil-based anesthesia with small-dose ketamine decreased intraoperative Remifentanil use and postoperative morphine consumption. These data demonstrate that N-methyl-D-aspartate antagonists, such as ketamine, can be a useful adjuvant to intraoperative Remifentanil.
Bruno Guignard - One of the best experts on this subject based on the ideXlab platform.
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Remifentanil induced postoperative hyperalgesia and its prevention with small dose ketamine
Anesthesiology, 2005Co-Authors: Vincent Joly, Philippe Richebe, Bruno Guignard, Dominique Fletcher, P Maurette, Daniel I Sessler, Marcel ChauvinAbstract:Background: Remifentanil-induced secondary hyperalgesia has been documented experimentally in both animals and healthy human volunteers, but never clinically. This study tested the hypotheses that increased pain sensitivity assessed by periincisional allodynia and hyperalgesia can occur after relatively large-dose intraoperative Remifentanil and that smalldose ketamine prevents this hyperalgesia. Methods: Seventy-five patients undergoing major abdominal surgery were randomly assigned to receive (1) intraoperative Remifentanil at 0.05 g kg 1 min 1 (small-dose Remifentanil); (2) intraoperative Remifentanil at 0.40 g kg 1 min 1 (largedose Remifentanil); or (3) intraoperative Remifentanil at 0.40 g kg 1 min 1 and 0.5 mg/kg ketamine just after the induction, followed by an intraoperative infusion of 5 g kg 1 min 1 until skin closure and then 2 g kg 1 min 1 for 48 h (large-dose Remifentanil‐ketamine). Pain scores and morphine consumption were recorded for 48 postoperative hours. Quantitative sensory tests, peak expiratory flow measures, and cognitive tests were performed at 24 and 48 h. Results: Hyperalgesia to von Frey hair stimulation adjacent to the surgical wound and morphine requirements were larger (P < 0.05) and allodynia to von Frey hair stimulation was greater (P < 0.01) in the large-dose Remifentanil group compared with the other two groups, which were comparable. There were no significant differences in pain, pressure pain detection threshold with an algometer, peak flow, cognitive tests, or side effects. Conclusion: A relatively large dose of intraoperative Remifentanil triggers postoperative secondary hyperalgesia. Remifentanil-induced hyperalgesia was prevented by small-dose ketamine, implicating an N-methyl-D-aspartate pain-facilitator process.
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supplementing desflurane Remifentanil anesthesia with small dose ketamine reduces perioperative opioid analgesic requirements
Anesthesia & Analgesia, 2002Co-Authors: Bruno Guignard, Daniel I Sessler, Carole Coste, Helene Costes, C Lebrault, W P Morris, Guy Simonnet, Marcel ChauvinAbstract:UNLABELLED Relative large-dose intraoperative Remifentanil could lead to the need for more postoperative analgesics. Intraoperative N-methyl-D-aspartate receptor antagonists, such as ketamine, decrease postoperative opioid use. We therefore tested the hypothesis that intraoperative small-dose ketamine improves postoperative analgesia after major abdominal surgery with Remifentanil-based anesthesia. Fifty patients undergoing abdominal surgery under Remifentanil-based anesthesia were randomly assigned to intraoperative ketamine or saline (control) supplementation. The initial ketamine dose of 0.15 mg/kg was followed by 2 microg. kg(-1). min(-1). In both groups, desflurane was kept constant at 0.5 minimum alveolar anesthetic concentration without N(2)O, and a Remifentanil infusion was titrated to autonomic responses. All patients were given 0.15 mg/kg of morphine 30 min before the end of surgery. Pain scores and morphine consumption were recorded for 24 postoperative h. Less of the Remifentanil was required in the Ketamine than in the Control group (P < 0.01). Pain scores were significantly larger in the Control group during the first 15 postoperative min but were subsequently similar in the two groups. The Ketamine patients required postoperative morphine later (P < 0.01) and received less morphine during the first 24 postoperative h: 46 mg (interquartile range, 34-58 mg) versus 69 mg (interquartile range, 41-87 mg, P < 0.01). No psychotomimetic symptoms were noted in either group. In conclusion, supplementing Remifentanil-based anesthesia with small-dose ketamine decreases intraoperative Remifentanil use and postoperative morphine consumption without increasing the incidence of side effects. Thus, intraoperative small-dose ketamine may be a useful adjuvant to intraoperative Remifentanil. IMPLICATIONS Supplementing Remifentanil-based anesthesia with small-dose ketamine decreased intraoperative Remifentanil use and postoperative morphine consumption. These data demonstrate that N-methyl-D-aspartate antagonists, such as ketamine, can be a useful adjuvant to intraoperative Remifentanil.
Frances Chung - One of the best experts on this subject based on the ideXlab platform.
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Remifentanil versus Remifentanil midazolam for ambulatory surgery during monitored anesthesia care
Anesthesiology, 1997Co-Authors: Martin Irwin Gold, Yungfong Sung, Marcia Y Clarke, N. T. Lim Uy, David W Watkins, Joel Yarmush, Walter G. Maurer, Frances Chung, Brenda D JamersonAbstract:Background: This study was designed to define the appropriate dose of Remifentanil hydrochloride alone or combined with midazolam to provide satisfactory comfort and maintain adequate respiration for a monitored anesthesia care setting. Methods : One hundred fifty-nine patients scheduled for outpatient surgery participated in this multicenter, double-blind study. Patients were randomly assigned to one of two groups: Remifentanil, 1 μg/kg, given over 30 s followed by a continuous infusion of 0.1 μg.kg min -1 (Remifentanil); Remifentanil, 0.5 μg/kg, given over 30 s followed by a continuous infusion of 0.05 μg. kg -1 min -1 (Remifentanil + midazolam). Five minutes after the start of the infusion, patients received a loading dose of saline placebo (Remifentanil) or midazolam, 1 mg, (Remifentanil + midazolam). If patients were not oversedated, a second dose of placebo or midazolam, 1 mg, was given. Remifentanil was titrated (in increments of 50% from the initial rate) to limit patient discomfort or pain intraoperatively, and the infusion was terminated at the completion of skin closure. Results: At the time of the local anesthetic, most patients in the Remifentanil and Remifentanil + midazolam groups experienced no pain (66% and 60%, respectively) and no discomfort (66% and 65%, respectively). The final mean (± SD) Remifentanil infusion rates were 0.12 ± 0.05 μg. kg -1 . min -1 (Remifentanil) and 0.07 ± 0.03 μg.kg -1 . min -1 (Remifentanil + midazolam). Fewer patients in the Remifentanil + midazolam group experienced nausea compared with the Remifentanil group (16% vs. 36%, respectively; P < 0.05). Four patients (5%) in the Remifentanil group and two patients (2%) in the Remifentanil + midazolam group experienced brief periods of oxygen desaturation (Sp o2 < 90%) and hypoventilation (< 8 breaths/ min). Conclusions: Remifentanil alone or combined with midazolam provided adequate analgesia and maintained adequate respiration at the doses reported. The low dose of Remifentanil combined with 2 mg midazolam, compared with Remifentanil alone, resulted in fewer side effects, slightly greater sedation, and less anxiety.
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Remifentanil versus Remifentanil/midazolam for Ambulatory Surgery during Monitored Anesthesia Care
Anesthesiology, 1997Co-Authors: Martin Irwin Gold, Yungfong Sung, Marcia Y Clarke, Joel Yarmush, Walter G. Maurer, Frances Chung, W. David Watkins, Brenda D JamersonAbstract:BACKGROUND This study was designed to define the appropriate dose of Remifentanil hydrochloride alone or combined with midazolam to provide satisfactory comfort and maintain adequate respiration for a monitored anesthesia care setting. METHODS One hundred fifty-nine patients scheduled for outpatient surgery participated in this multicenter, double-blind study. Patients were randomly assigned to one of two groups: Remifentanil, 1 microgram/kg, given over 30 s followed by a continuous infusion of 0.1 microgram.kg-1.min-1 (Remifentanil), Remifentanil, 0.5 microgram/kg, given over 30 s followed by a continuous infusion of 0.05 microgram.kg-1.min-1 (Remifentanil+midazolam). Five minutes after the start of the infusion, patients received a loading dose of saline placebo (Remifentanil) or midazolam, 1 mg, (Remifentanil+midazolam). If patients were not oversedated, a second dose of placebo or midazolam, 1 mg, was given. Remifentanil was titrated (in increments of 50% from the initial rate) to limit patient discomfort or pain intraoperatively, and the infusion was terminated at the completion of skin closure. RESULTS At the time of the local anesthetic, most patients in the Remifentanil and Remifentanil+midazolam groups experienced no pain (66% and 60%, respectively) and no discomfort (66% and 65%, respectively). The final mean (+/-SD) Remifentanil infusion rates were 0.12 +/- 0.05 microgram.kg-1.min-1 (Remifentanil) and 0.07 +/- 0.03 microgram.kg-1.min-1 (Remifentanil+midazolam). Fewer patients in the Remifentanil+midazolam group experienced nauses compared with the Remifentanil group (16% vs. 36%, respectively; P < 0.05). Four patients (5%) in the Remifentanil group and two patients (2%) in the Remifentanil+midazolam group experienced brief periods of oxygen desaturation (SpO2 < 90%) and hypoventilation (< 8 breaths/ min). CONCLUSIONS Remifentanil alone or combined with midazolam provided adequate analgesia and maintained adequate respiration at the doses reported. The low dose of Remifentanil combined with 2 mg midazolam, compared with Remifentanil alone, resulted in fewer side effects, slightly greater sedation, and less anxiety.
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Remifentanil compared with alfentanil for ambulatory surgery using total intravenous anesthesia
Anesthesia & Analgesia, 1997Co-Authors: Beverly K Philip, Walter G. Maurer, Frances Chung, Philip E Scuderi, Thomas J Conahan, John J Angel, Surinder K Kallar, Elizabeth P Skinner, Brenda D JamersonAbstract:The purpose of this study was to test the hypothesis that using a 1:4 ratio of Remifentanil to alfentanil, a Remifentanil infusion would provide better suppression of intraoperative responses and comparable recovery profiles after ambulatory laparoscopic surgery than an alfentanil infusion, as part of total intravenous anesthesia. Two hundred ASA physical status I, II, or III adult patients participated in this multicenter, double-blind, parallel group study. Patients were randomly assigned 2:1 to either the Remifentanil-propofol or alfentanil-propofol regimens. The anesthesia sequence was propofol (2 mg/kg intravenously [IV] followed by 150 micrograms.kg-1.min-1), and either Remifentanil (1 microgram/kg IV followed by 0.5 microgram.kg-1.min-1)of alfentanil (20 micrograms/kg IV followed by 2 micrograms.kg-1.min-1), and vecuronium. After trocar insertion, infusion rates were decreased (propofol to 75 micrograms.kg-1.min-1; Remifentanil to 0.25 microgram.kg-1.min-1; alfentanil to 1 microgram.kg-1.min-1). Alfentanil and propofol were discontinued at 10 and 5 min, respectively, before the anticipated end of surgery (last surgical suture); Remifentanil was discontinued at the end of surgery. Recovery times were calculated from the end of surgery. The median duration of surgery was similar between groups (39 min for Remifentanil versus 34 min for alfentanil). A smaller proportion of Remifentanil patients than alfentanil patients had any intraoperative responses (53% vs 71%, P = 0.029), had responses to trocar insertion (11% vs 32%, P < 0.001), or required dosage adjustments during maintenance (24% vs 41%, P < 0.05). Early awakening times were similar. Remifentanil patients qualified for Phase 1 discharge later and were given postoperative analgesics sooner than alfentanil patients (P < 0.05). Actual discharge times from the ambulatory center were similar between groups (174 min for Remifentanil versus 204 min for alfentanil) (P = 0.06). In conclusion, Remifentanil can be used for maintenance of anesthesia in a 1:4 ratio compared with alfentanil, for total IV anesthesia in ambulatory surgery. This dose of Remifentanil provides more effective suppression of intraoperative responses and does not result in prolonged awakening.
Walter G. Maurer - One of the best experts on this subject based on the ideXlab platform.
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Remifentanil versus Remifentanil midazolam for ambulatory surgery during monitored anesthesia care
Anesthesiology, 1997Co-Authors: Martin Irwin Gold, Yungfong Sung, Marcia Y Clarke, N. T. Lim Uy, David W Watkins, Joel Yarmush, Walter G. Maurer, Frances Chung, Brenda D JamersonAbstract:Background: This study was designed to define the appropriate dose of Remifentanil hydrochloride alone or combined with midazolam to provide satisfactory comfort and maintain adequate respiration for a monitored anesthesia care setting. Methods : One hundred fifty-nine patients scheduled for outpatient surgery participated in this multicenter, double-blind study. Patients were randomly assigned to one of two groups: Remifentanil, 1 μg/kg, given over 30 s followed by a continuous infusion of 0.1 μg.kg min -1 (Remifentanil); Remifentanil, 0.5 μg/kg, given over 30 s followed by a continuous infusion of 0.05 μg. kg -1 min -1 (Remifentanil + midazolam). Five minutes after the start of the infusion, patients received a loading dose of saline placebo (Remifentanil) or midazolam, 1 mg, (Remifentanil + midazolam). If patients were not oversedated, a second dose of placebo or midazolam, 1 mg, was given. Remifentanil was titrated (in increments of 50% from the initial rate) to limit patient discomfort or pain intraoperatively, and the infusion was terminated at the completion of skin closure. Results: At the time of the local anesthetic, most patients in the Remifentanil and Remifentanil + midazolam groups experienced no pain (66% and 60%, respectively) and no discomfort (66% and 65%, respectively). The final mean (± SD) Remifentanil infusion rates were 0.12 ± 0.05 μg. kg -1 . min -1 (Remifentanil) and 0.07 ± 0.03 μg.kg -1 . min -1 (Remifentanil + midazolam). Fewer patients in the Remifentanil + midazolam group experienced nausea compared with the Remifentanil group (16% vs. 36%, respectively; P < 0.05). Four patients (5%) in the Remifentanil group and two patients (2%) in the Remifentanil + midazolam group experienced brief periods of oxygen desaturation (Sp o2 < 90%) and hypoventilation (< 8 breaths/ min). Conclusions: Remifentanil alone or combined with midazolam provided adequate analgesia and maintained adequate respiration at the doses reported. The low dose of Remifentanil combined with 2 mg midazolam, compared with Remifentanil alone, resulted in fewer side effects, slightly greater sedation, and less anxiety.
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Remifentanil versus Remifentanil/midazolam for Ambulatory Surgery during Monitored Anesthesia Care
Anesthesiology, 1997Co-Authors: Martin Irwin Gold, Yungfong Sung, Marcia Y Clarke, Joel Yarmush, Walter G. Maurer, Frances Chung, W. David Watkins, Brenda D JamersonAbstract:BACKGROUND This study was designed to define the appropriate dose of Remifentanil hydrochloride alone or combined with midazolam to provide satisfactory comfort and maintain adequate respiration for a monitored anesthesia care setting. METHODS One hundred fifty-nine patients scheduled for outpatient surgery participated in this multicenter, double-blind study. Patients were randomly assigned to one of two groups: Remifentanil, 1 microgram/kg, given over 30 s followed by a continuous infusion of 0.1 microgram.kg-1.min-1 (Remifentanil), Remifentanil, 0.5 microgram/kg, given over 30 s followed by a continuous infusion of 0.05 microgram.kg-1.min-1 (Remifentanil+midazolam). Five minutes after the start of the infusion, patients received a loading dose of saline placebo (Remifentanil) or midazolam, 1 mg, (Remifentanil+midazolam). If patients were not oversedated, a second dose of placebo or midazolam, 1 mg, was given. Remifentanil was titrated (in increments of 50% from the initial rate) to limit patient discomfort or pain intraoperatively, and the infusion was terminated at the completion of skin closure. RESULTS At the time of the local anesthetic, most patients in the Remifentanil and Remifentanil+midazolam groups experienced no pain (66% and 60%, respectively) and no discomfort (66% and 65%, respectively). The final mean (+/-SD) Remifentanil infusion rates were 0.12 +/- 0.05 microgram.kg-1.min-1 (Remifentanil) and 0.07 +/- 0.03 microgram.kg-1.min-1 (Remifentanil+midazolam). Fewer patients in the Remifentanil+midazolam group experienced nauses compared with the Remifentanil group (16% vs. 36%, respectively; P < 0.05). Four patients (5%) in the Remifentanil group and two patients (2%) in the Remifentanil+midazolam group experienced brief periods of oxygen desaturation (SpO2 < 90%) and hypoventilation (< 8 breaths/ min). CONCLUSIONS Remifentanil alone or combined with midazolam provided adequate analgesia and maintained adequate respiration at the doses reported. The low dose of Remifentanil combined with 2 mg midazolam, compared with Remifentanil alone, resulted in fewer side effects, slightly greater sedation, and less anxiety.
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Remifentanil compared with alfentanil for ambulatory surgery using total intravenous anesthesia
Anesthesia & Analgesia, 1997Co-Authors: Beverly K Philip, Walter G. Maurer, Frances Chung, Philip E Scuderi, Thomas J Conahan, John J Angel, Surinder K Kallar, Elizabeth P Skinner, Brenda D JamersonAbstract:The purpose of this study was to test the hypothesis that using a 1:4 ratio of Remifentanil to alfentanil, a Remifentanil infusion would provide better suppression of intraoperative responses and comparable recovery profiles after ambulatory laparoscopic surgery than an alfentanil infusion, as part of total intravenous anesthesia. Two hundred ASA physical status I, II, or III adult patients participated in this multicenter, double-blind, parallel group study. Patients were randomly assigned 2:1 to either the Remifentanil-propofol or alfentanil-propofol regimens. The anesthesia sequence was propofol (2 mg/kg intravenously [IV] followed by 150 micrograms.kg-1.min-1), and either Remifentanil (1 microgram/kg IV followed by 0.5 microgram.kg-1.min-1)of alfentanil (20 micrograms/kg IV followed by 2 micrograms.kg-1.min-1), and vecuronium. After trocar insertion, infusion rates were decreased (propofol to 75 micrograms.kg-1.min-1; Remifentanil to 0.25 microgram.kg-1.min-1; alfentanil to 1 microgram.kg-1.min-1). Alfentanil and propofol were discontinued at 10 and 5 min, respectively, before the anticipated end of surgery (last surgical suture); Remifentanil was discontinued at the end of surgery. Recovery times were calculated from the end of surgery. The median duration of surgery was similar between groups (39 min for Remifentanil versus 34 min for alfentanil). A smaller proportion of Remifentanil patients than alfentanil patients had any intraoperative responses (53% vs 71%, P = 0.029), had responses to trocar insertion (11% vs 32%, P < 0.001), or required dosage adjustments during maintenance (24% vs 41%, P < 0.05). Early awakening times were similar. Remifentanil patients qualified for Phase 1 discharge later and were given postoperative analgesics sooner than alfentanil patients (P < 0.05). Actual discharge times from the ambulatory center were similar between groups (174 min for Remifentanil versus 204 min for alfentanil) (P = 0.06). In conclusion, Remifentanil can be used for maintenance of anesthesia in a 1:4 ratio compared with alfentanil, for total IV anesthesia in ambulatory surgery. This dose of Remifentanil provides more effective suppression of intraoperative responses and does not result in prolonged awakening.
