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[Acute selective tolerance to remifentanil after prolonged infusion]
E Calderón1, A Pernia, A Ysasi
1Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Puerta del Mar, Cádiz.
Revista Espanola De Anestesiologia Y Reanimacion
|November 29, 2002
Summary
Patients receiving remifentanil anesthesia for over 3 hours may develop acute tolerance. This tolerance affects sedation and ventilation, but not pain relief, necessitating further clinical trials.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Remifentanil is an ultra-short-acting opioid anesthetic used for prolonged surgical procedures.
- Acute tolerance to opioids is characterized by decreased efficacy or increased dose requirements after exposure.
Observation:
- Three patients receiving continuous remifentanil infusion (0.8-1.25 µg/kg/min) for >3 hours showed sedation and ventilatory depression upon emergence.
- These effects persisted despite maintenance doses of remifentanil >0.8 µg/kg/min.
Findings:
- The observed phenomena suggest selective acute tolerance to remifentanil's sedative and ventilatory depressant effects.
- Antinociceptive effects of remifentanil appeared unaffected by the prolonged infusion and potential tolerance.
Implications:
- The development of acute tolerance to remifentanil may impact patient recovery and require dose adjustments.
- Further clinical trials are warranted to investigate remifentanil tolerance and its perioperative consequences.