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Analgesia And Anesthesia
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Michele Mele, Valentina Bellussi, Laura Felder
Parenteral opioids continue to have a role in managing labor pain globally and are the most widely used of the systemic medications for labor analgesia. Opioids are low cost, easy to use, and do not require specialized personnel or equipment to be delivered safely. There are a variety of opioid agonist-antagonists in clinical use such as butorphanol (Stadol) or nalbuphine (Nubain) or pure opioid agonists such as meperidine, fentanyl, morphine, hydromorphone, or their derivatives. More recently, remifentanil, an ultra-short-acting opioid without active metabolites, has been utilized and is administered only as a patient-controlled intravenous (IV) infusion.
Obstetric Analgesia
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
Studies have shown remifentanil to provide satisfactory pain relief in labour. However, despite all these advantages, remifentanil can cause serious respiratory complications and needs monitoring to ensure safety.
Critical care, neurology and analgesia
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Remifentanil is a synthetic opioid with a similar potency to fentanyl and with cardiorespiratory effects similar to other opioids. It is broken down by plasma esterases and has a very short half-life, which is unaffected by the duration of its administration, offering the prospect of very rapid wakening in all age groups. Remifentanil is an expensive agent and prolonged use is characterised by the rapid development of tolerance, which further adds to the cost. There has been only limited success in using remifentanil as a single agent for the prolonged sedation of mechanically ventilated children in PICU, but it may prove effective as an agent for procedural sedation in this environment.
Different effects of intravenous and local anesthesia in patients undergoing ultrasound-guided radiofrequency ablation of thyroid nodules: a prospective cohort study
Published in International Journal of Hyperthermia, 2022
Shuhang Gao, Yalin Zhu, Mengying Tong, Lina Wang, Shuangsong Ren, Liu Rui, Fang Yang, Zhiqing Lian, Ying Che
Major and minor complications occurred with both methods of anesthesia. Although there is no evidence to prove that the incidence of adverse events is different due to the small number of cases, we observed slightly different types of complications in both groups. Patients with IV have specific symptoms of post-procedural nausea and intra-procedural snoring. These conditions are considered to be caused by the application of intravenous anesthetics. The most common side effects of propofol and remifentanil are gastrointestinal reactions, such as nausea and vomiting. Snoring may be caused by excessive sedation or obesity (body mass index, 28.1 kg/m2). This suggests that individualized medication dosage and close anesthesia care are significantly important during IV induction.
Moderate sedation with dexmedetomidine–remifentanil is safer than deep sedation with propofol–remifentanil for endobronchial ultrasound while providing comparable quality: a randomized double-blind trial
Published in Expert Review of Respiratory Medicine, 2022
Silvia Bermejo, Begoña Covas, Teresa Silva-Costa-Gomes, Albert Sánchez-Font, Víctor Curull, Àlex Pérez-Ramos, Anna Mases, Lluís Gallart
We chose safety as the primary outcome although satisfaction or diagnostic yield could also be the main outcomes. Safety is probably the main concern for both anesthesiologists and pneumologists, and the remaining outcomes could be related to security. Dexmedetomidine is a safe drug, but its association with high dose remifentanil could increase the risk of respiratory depression and this drug combination had to be properly evaluated. Concerning diagnostic yield, the impact of sedation type on efficacy of EBUS according to final diagnoses is still unknown. A retrospective analysis found that diagnostic yield was superior with deep sedation in comparison to moderate sedation [5]. However other authors found comparable diagnostic yield between moderate and deep sedation [10,13,37]. Furthermore, a systematic review of the role of sedation in EBUS also concluded that both sedations were similar/equal for diagnostic yield [12]. Although our study was not designed to compare the diagnostic yield of two types of sedations, we did not find statistically differences between them. Hence, our results are in agreement with the majority of the publications on the matter. Further studies are probably needed to clarify this topic.
How Integrated Anesthesia Communication Leads to Dependable IONM Data
Published in The Neurodiagnostic Journal, 2021
Veronica O. Busso, John J. McAuliffe
Despite adequate hypnosis with propofol, when an incision is made the patient may still move. The addition of opioids helps prevent movement with surgery and avoids the potential cardiac depression associated with increasing the propofol infusion alone (Ferenets et al. 2007). Typically, remifentanil is the opioid of choice when providing care for complex anesthesia and surgical patients. This combination allows for the fastest wake-up if a wake-up test is initiated intraoperatively. Sufentanil is also an appropriate adjunct however wake up is significantly slower. It is also important to be cognizant of drug shortages and patient costs when developing an anesthesia plan. Obviously, a safe patient care model is the priority. If performing a posterior spinal fusion in a complex neuromuscular spine and the surgeon is anticipating changes, performing osteotomies, remifentanil may prove a better choice as you are anticipating the need for a wake-up test. However, if the patient is an idiopathic spine with a low degree of curvature and the surgeon is confident of the outcome, remifentanil is on drug shortage, perhaps sufentanil is an appropriate choice as an adjunct (Table 4).