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Severe cardiovascular depression with remifentanil.
P Elliott1, R O'Hare, K M Bill
1Department of Clinical Anaesthesia, Royal Victoria Hospital. Belfast, United Kingdom. peter.elliott@royalhospitals.n-i.nhs.uk
Anesthesia and Analgesia
|June 27, 2000
Summary
Rapid bolus administration of remifentanil can cause severe hemodynamic instability in patients undergoing coronary artery bypass grafting. Slow infusion is recommended for this patient population to ensure safety and stability.
Area of Science:
- Anesthesiology
- Cardiovascular Pharmacology
Background:
- Remifentanil is a potent ultra-short-acting opioid analgesic.
- Coronary artery bypass grafting (CABG) patients present unique hemodynamic challenges.
- Propofol is commonly used for anesthesia induction and maintenance.
Purpose of the Study:
- To compare the hemodynamic effects of different bolus administration rates of remifentanil.
- To assess the safety of remifentanil bolus administration in CABG patients.
Main Methods:
- Eight patients undergoing CABG were enrolled.
- Remifentanil was administered at varying bolus rates (1.0, 0.33, 0.2 microg/kg/min).
- Hemodynamic parameters were monitored throughout administration.
Main Results:
- The study was terminated early due to severe hemodynamic instability in four patients.
- Instability included severe bradycardia and hypotension with decreased systemic vascular resistance.
- One patient experienced myocardial ischemia; all patients responded to interventions.
Conclusions:
- Bolus administration of remifentanil is associated with significant hemodynamic risks in CABG patients.
- Slow infusion of remifentanil is strongly recommended for this patient group.
- Careful hemodynamic monitoring is crucial during remifentanil administration.