Observational study on the use of remifentanil in general anesthesia. Drug utilisation research

The use of remifentanil in routine clinical practice during the induction and maintenance of general anesthesia as well as the quality of awakening after anesthesia and post-operative pain management have been assessed.

A total of 123 Italian anesthetists were involved; data of 1 295 patients (ASA I-IV) undergoing surgical interventions (range duration of intervention 30-240 min), in which remifentanil was used according to internal anesthesiologic procedures, have been collected. The most common modality of anesthesia induction is to use a syringe pump to start remifentanil administration. The remifentanil dosage mainly used to start the infusion was 0.2 mg/kg/min (29.2% of patients), as well as at the beginning of maintenance of anesthesia (35.1%).

During maintenance of anesthesia, 36% of surgical interventions did not need changes of remifentanil infusion rate, whereas in the rest of the intervention 1 to 4 changes were done. The induction of anesthesia is predominantly intravenous with concomitant use of propofol and TPS, whereas the agents most frequently used during maintenance were sevoflurane (49.8%), nitrous oxide (43.7%) and propofol (35.2%). Awakening was mainly judged rapid in 93% of interventions; the postoperative pain at awakening was judged nil in 61% of cases and severe in 1.5%. The administration of analgesic treatment mainly started prior to the end of intervention (70% cases).

This Drug Utilisation Research study demonstrated that the use of remifentanil according to its peculiar pharmacological profile, such as potent opioid with rapid onset and offset of action, the synergistic effect with propofol and the right management of post-operative pain are widely consolidated in Italian clinical practice.