Remifentanil for the insertion and removal of long-term central venous access during monitored anesthesia care.

Hdl Handle:
http://hdl.handle.net/10147/207619
Title:
Remifentanil for the insertion and removal of long-term central venous access during monitored anesthesia care.
Authors:
Burlacu, Crina L; McKeating, Kevin; McShane, Alan J
Affiliation:
Department of Anesthesia, Intensive Care and Pain Medicine, St. Vincent's, University Hospital, Elm Park, Dublin 4, Ireland. crina@ireland.com
Citation:
J Clin Anesth. 2011 Jun;23(4):286-91.
Journal:
Journal of clinical anesthesia
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207619
DOI:
10.1016/j.jclinane.2010.12.007
PubMed ID:
21663812
Abstract:
STUDY OBJECTIVE: To determine the analgesic efficacy of three different rates of remifentanil infusion in patients undergoing insertion or removal of long-term central venous access devices during monitored anesthesia care and local anesthetic field infiltration. DESIGN: Double-blinded, randomized, controlled study. SETTING: Operating theatre of an University hospital. PATIENTS: 44 unpremedicated, ASA physical status 1 and 2 patients, aged 18-65 years, undergoing insertion or removal of a Port-a-Cath or Hickman catheter. INTERVENTIONS: Patients sedated with a propofol target-controlled infusion were randomly allocated to three groups: Group R25 (n = 14), Group R50 (n = 15), and Group R75 (n = 15), to receive remifentanil 0.025, 0.05, and 0.075 mug/kg/min, respectively. Rescue remifentanil 0.5 mug/kg was administered for pain scores > 3. The remifentanil infusion rate was maintained constant unless respiratory and/or cardiovascular unwanted events occurred, whereupon the rate was adjusted in 0.01 mug/kg/min decrements as necessary. MEASUREMENTS: Pain scores (primary outcome), sedation, and movement scores (secondary outcomes) were assessed during local anesthetic infiltration of the anterior chest wall and 5 other procedural steps. MAIN RESULTS: All infusion rates had equal analgesic efficacy, as shown by comparable pain scores, number of rescue boluses, and number of patients requiring rescue analgesia. Excessive sedation was associated with the highest remifentanil rate such that Group R75 patients were significantly more sedated than Groups R25 or R50 at selective procedural steps (P < 0.05). More Group R75 patients (6/15) required remifentanil rate reduction than did patients from Group R50 (1/15) or Group R25 (0/14), P < 0.01, most commonly because of respiratory depression. CONCLUSIONS: For the insertion or removal of long-term central venous access devices, all three remifentanil infusion rates proved to be equally analgesic-efficient. However, the excessive sedation and tendency to respiratory and cardiovascular events associated with the highest remifentanil infusion rate renders such a rate less desirable for this purpose.
Language:
eng
MeSH:
Adult; Aged; Analgesics, Opioid/administration & dosage/adverse effects/*therapeutic use; Anesthetics, Intravenous/administration & dosage/therapeutic use; Catheterization, Central Venous/*methods; *Catheters, Indwelling; Device Removal; Double-Blind Method; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Pain/drug therapy/etiology; Piperidines/administration & dosage/adverse effects/*therapeutic use; Propofol/administration & dosage/therapeutic use; Prospective Studies; Young Adult
ISSN:
1873-4529 (Electronic); 0952-8180 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorBurlacu, Crina Len_GB
dc.contributor.authorMcKeating, Kevinen_GB
dc.contributor.authorMcShane, Alan Jen_GB
dc.date.accessioned2012-02-01T10:33:03Z-
dc.date.available2012-02-01T10:33:03Z-
dc.date.issued2012-02-01T10:33:03Z-
dc.identifier.citationJ Clin Anesth. 2011 Jun;23(4):286-91.en_GB
dc.identifier.issn1873-4529 (Electronic)en_GB
dc.identifier.issn0952-8180 (Linking)en_GB
dc.identifier.pmid21663812en_GB
dc.identifier.doi10.1016/j.jclinane.2010.12.007en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207619-
dc.description.abstractSTUDY OBJECTIVE: To determine the analgesic efficacy of three different rates of remifentanil infusion in patients undergoing insertion or removal of long-term central venous access devices during monitored anesthesia care and local anesthetic field infiltration. DESIGN: Double-blinded, randomized, controlled study. SETTING: Operating theatre of an University hospital. PATIENTS: 44 unpremedicated, ASA physical status 1 and 2 patients, aged 18-65 years, undergoing insertion or removal of a Port-a-Cath or Hickman catheter. INTERVENTIONS: Patients sedated with a propofol target-controlled infusion were randomly allocated to three groups: Group R25 (n = 14), Group R50 (n = 15), and Group R75 (n = 15), to receive remifentanil 0.025, 0.05, and 0.075 mug/kg/min, respectively. Rescue remifentanil 0.5 mug/kg was administered for pain scores > 3. The remifentanil infusion rate was maintained constant unless respiratory and/or cardiovascular unwanted events occurred, whereupon the rate was adjusted in 0.01 mug/kg/min decrements as necessary. MEASUREMENTS: Pain scores (primary outcome), sedation, and movement scores (secondary outcomes) were assessed during local anesthetic infiltration of the anterior chest wall and 5 other procedural steps. MAIN RESULTS: All infusion rates had equal analgesic efficacy, as shown by comparable pain scores, number of rescue boluses, and number of patients requiring rescue analgesia. Excessive sedation was associated with the highest remifentanil rate such that Group R75 patients were significantly more sedated than Groups R25 or R50 at selective procedural steps (P < 0.05). More Group R75 patients (6/15) required remifentanil rate reduction than did patients from Group R50 (1/15) or Group R25 (0/14), P < 0.01, most commonly because of respiratory depression. CONCLUSIONS: For the insertion or removal of long-term central venous access devices, all three remifentanil infusion rates proved to be equally analgesic-efficient. However, the excessive sedation and tendency to respiratory and cardiovascular events associated with the highest remifentanil infusion rate renders such a rate less desirable for this purpose.en_GB
dc.language.isoengen_GB
dc.subject.meshAdulten_GB
dc.subject.meshAgeden_GB
dc.subject.meshAnalgesics, Opioid/administration & dosage/adverse effects/*therapeutic useen_GB
dc.subject.meshAnesthetics, Intravenous/administration & dosage/therapeutic useen_GB
dc.subject.meshCatheterization, Central Venous/*methodsen_GB
dc.subject.mesh*Catheters, Indwellingen_GB
dc.subject.meshDevice Removalen_GB
dc.subject.meshDouble-Blind Methoden_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshInfusions, Intravenousen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshPain/drug therapy/etiologyen_GB
dc.subject.meshPiperidines/administration & dosage/adverse effects/*therapeutic useen_GB
dc.subject.meshPropofol/administration & dosage/therapeutic useen_GB
dc.subject.meshProspective Studiesen_GB
dc.subject.meshYoung Adulten_GB
dc.titleRemifentanil for the insertion and removal of long-term central venous access during monitored anesthesia care.en_GB
dc.contributor.departmentDepartment of Anesthesia, Intensive Care and Pain Medicine, St. Vincent's, University Hospital, Elm Park, Dublin 4, Ireland. crina@ireland.comen_GB
dc.identifier.journalJournal of clinical anesthesiaen_GB
dc.description.provinceLeinster-
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