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Remifentanil for general anaesthesia: a systematic review.
R Komatsu1, A M Turan, M Orhan-Sungur
1Department of Anaesthesiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjukuku, Tokyo 162-8666, Japan.
Anaesthesia
|November 10, 2007
Summary
Remifentanil offers deeper anesthesia with fewer noxious stimuli responses but more bradycardia and hypotension compared to short-acting opioids. It enables faster recovery but increases postoperative analgesic needs and shivering, though it reduces respiratory events.
Area of Science:
- Anesthesiology
- Pharmacology
- Critical Care Medicine
Background:
- Opioids are essential for general anesthesia.
- Remifentanil is an ultra-short-acting opioid.
- Comparisons with traditional short-acting opioids are crucial.
Purpose of the Study:
- To systematically review randomized controlled trials comparing remifentanil with short-acting opioids (fentanyl, alfentanil, sufentanil).
- To evaluate the efficacy and safety of remifentanil in general anesthesia.
Main Methods:
- Quantitative systematic review of randomized controlled trials.
- Inclusion of 85 trials with 13,057 patients.
- Analysis of intraoperative and postoperative outcomes.
Main Results:
- Remifentanil showed deeper anesthesia (fewer noxious stimuli responses) but increased bradycardia and hypotension.
- Faster extubation times and reduced postoperative respiratory events were observed.
- Increased postoperative analgesic requirements and shivering were noted.
Conclusions:
- Remifentanil may be beneficial for specific patients, particularly when postoperative respiratory depression is a concern.
- It does not appear to offer advantages for lengthy, major surgical interventions.
- Clinical decisions should weigh benefits of faster recovery against increased analgesic needs and shivering.
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