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Rational use of opioids.

P Mastronardi1, T Cafiero

  • 1Department of Surgical, Anesthesiological and Emergency Sciences, University Federico II, Naples, Italy.

Minerva Anestesiologica
|May 29, 2001
PubMed
Summary

Opioids are crucial for pain and anxiety management in intensive care units (ICU), ensuring patient cooperation for procedures. Choosing the right opioid, like fentanyl or remifentanil, depends on patient stability and treatment duration.

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Area of Science:

  • Critical Care Medicine
  • Pharmacology
  • Anesthesiology

Background:

  • Analgesia and sedation are vital ancillary strategies in intensive care units (ICUs).
  • Opioids manage pain, anxiety, and agitation, enabling safe diagnostic and therapeutic procedures.
  • Commonly used ICU opioids include morphine, fentanyl, sufentanil, and remifentanil.

Purpose of the Study:

  • To review the role and selection of opioids for analgesia and sedation in the ICU.
  • To highlight the pharmacokinetic and pharmacodynamic considerations for choosing specific opioids.
  • To discuss indications, potential benefits, and adverse effects of opioid use in critically ill patients.

Main Methods:

  • Review of current literature on opioid use in intensive care settings.
  • Analysis of pharmacokinetic and pharmacodynamic properties of commonly used ICU opioids.
  • Examination of clinical indications and potential protective effects of opioids.

Main Results:

  • Opioid selection is based on pharmacokinetics and pharmacodynamics, with fentanyl and sufentanil favored for hemodynamic stability.
  • Short-acting remifentanil offers advantages for prolonged infusions and in patients with organ failure due to its organ-independent metabolism.
  • Opioids can provide cardiac and neuroprotection, potentially through opiate receptor stimulation.

Conclusions:

  • Opioid analgesia and sedation are essential in ICUs for patient comfort and procedural safety.
  • Careful selection of opioids based on patient condition and drug properties is critical.
  • Potential benefits include cardiac and neuroprotection, but tolerance and withdrawal must be managed.

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