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Showing 4 results for Remifentanil
The effect of low-dose ketamine infusion on the remifentanil induced hemodynamic changes during general anesthesia
Beigmohamadi M T, Khan Z H, Mahoori A R,
Volume 65, Issue 11 (2-2008)
Abstract

Background: Remifentanil is known to produce side-effects of hypotension and bradycardia. In this study, we examine the effect of low-dose ketamine infusion on the heart rate and blood pressure of patients anesthetized with remifentanil.

Methods: In a randomized clinical trial, 54 patients aged 20-50 years old, with ASA physical status Ι, were studied in two groups (n=27), Ketamine- Remifentanil (K-R group) and Placebo- Remifentanil (P-R group). Exclusion criteria were ASA physical status >1, gastroesophageal reflux, tachycardia, bradycardia, systemic diseases, use of antihypertensive drugs, difficult intubations, risk of aspiration and contraindications of ketamine. Remifentanil was started at a rate of 0.5 µg. kg-1. min-1 and anesthesia was induced with thiopental sodium 2 mg.kg-1. Maintenance of anesthesia included halothane and nitrous oxide/oxygen mixture. Remifentanil infusion was continued in both groups at a rate of 0.5 µg.kg-1.min-1. In the K-R group, ketamine was started with an infusion rate of 10 µg.kg-1. min-1, 10 minutes after intubation, while in the P-R group, normal saline was started with the same dose of remifentanil. Heart rate, systolic, diastolic and mean arterial blood pressure were measured and compared at 1, 3, 5, 10, 15, 20, 25 and 30 minutes.

Results: No significant differences were found between basic patient characteristics of mean of age, sex, weight, systolic, diastolic and mean arterial blood pressure and heart rate (p>0.2) in the two groups. However, the rate of systolic, diastolic and mean arterial blood pressure changes in the P-R group was significantly greater than that of the K-R group (p<0.006). Heart rate changes were similar between the two groups (p=0.6). Incident of severe hypotension (a decrease of more than 25% of the basic value) was less in the K-R group than that of the P-R group (11% vs. 89% p=0.000).

Conclusion: Low-dose ketamine infusion modulates the effect of remifentanil-induced hypotension and provides better hemodynamic stability during general anesthesia.


Comparing hemodynamic changes during endoscopic sinus surgery: remifentanil/isofluran versus remifentanil/propofol
Sadeghi Sm, Seyedmehdi Sa, Narimani Zamanabadi M, Sadeghi Sa,
Volume 68, Issue 12 (3-2011)
Abstract
Background: Sinus surgeries are usually associated with bleeding, thus can result in hemodynamic instability. This study investigated the hemodynamic changes induced by remifentanil plus isoflurane administration in comparison with propofol plus remifentanil in patients undergoing sinus surgery.
Methods: In this randomized clinical trial study, 96 patients were divided into two groups of isoflurane (1.2 MAC) plus remifentanil (44 patients, group A) and propofol (100 μg/kg/min) plus remifentanil (52 patients, group B). Twenty-two patients in group A and 23 in group B were male. The remifentanil dosage (0.1 μg/kg/min) was equal in both groups and all received 500 ml isotonic solution during the operation too.  Premedications and anesthetic inductions of both groups were similar. The variables included age, BMI, blood loss during surgery, systolic and diastolic blood pressures, pulse rate and mean arterial blood pressure.
Results: The mean age, BMI, amount of blood loss, mean systolic (30 minutes before and after the intervention) and diastolic blood pressures (60 minutes before and after the intervention), pulse rate (30 and 60 minutes before and after the intervention), mean arterial blood pressure (60 minutes before and after the intervention) were similar in both groups. The average mean arterial blood pressure, 30 minutes after the intervention (p=0.027) and the mean diastolic blood pressure, 30 minutes after the intervention (p=0.011) in the case group had statistically significant differences with the controls.
Conclusion: Based on this study, the combination of isoflurane plus remifentanil could better maintain the hemodynamic stability during sinus surgeries.


Comparing ‘remifentanil-propofol’ and ‘fentanyl-propofol’ in patients undergoing craniotomy for supratentorial space-occupying lesions
Khalili Gh, Sajedi P, Yousef Zadeghan S,
Volume 70, Issue 9 (12-2012)
Abstract

Background: Control of intracranial pressure (ICP) before, during and after neurosurgical operations is crucially important. Therefore, trying different methods and drug combinations to attain this goal is an ongoing effort in anesthesiology. In this study we compared two combinations of a narcotic agent with propofol in neurosurgical operations to control intracranial pressure.
Methods: In this prospective randomized double-blind clinical trial, we enrolled 34 patients with supratentorial brain tumors who were candidates for craniotomy in Alzahra Hospital in Isfahan, Iran from April 2008 to April 2009. The patients were randomly divided into two groups of 17, in whom the first and the second group, respectively, received a combination of "propofol and fentanyl" and a combination of "propofol and remifentanyl" as maintenance of anesthesia. The hemodynamic status, ICP during the surgery, and post-surgical complications in recovery unit were observed for and registered in a questionnaire.
Results: Hemodynamic status was similar in both groups and they did not differ in recovery complications except for pain which was more prevalent in remifentanil group (P<0.03). Although the patients in fentanyl group better responded to the drug for lowering ICP than remifentanyl group, but the difference was not statistically significant.
Conclusion: There is no difference between these two anesthetic agent combinations and both could be useful in the anesthesia of neurosurgical operations. However combination of propofol and fentanyl seem to be superior because of more pain relief and a smoother recovery period.

 


Comparison of the effect of two doses of remifentanil infusion on the amount of bleeding, intraoperative hemodynamic changes and complications after rhinoplasty surgery with general anesthesia
Hamidreza Shetabi, Mahsa Mohammadrezaei ,
Volume 81, Issue 7 (10-2023)
Abstract
Background: This study was conducted to compare the effect of two doses of remifentanil infusion on the amount of bleeding, intraoperative hemodynamic changes, and complications after rhinoplasty surgery with general anesthesia.
Methods: This prospective randomized clinical trial study was conducted on 80 patients who were candidates for rhinoplasty from March 1401 to August 1402 in Al-Zahra Hospital, Isfahan, Iran. The participants were divided into two groups of 40 people using random allocation software. remifentanil infusion was adjusted in the first group with a dose of 0.15-0.25 mg/kg/min and in the second group with a dose of 0.25-0.35 mg/kg/min. The goal was to maintain mean arterial pressure (MAP) between 60 and 65 mmHg, to achieve this goal, reducing or increasing the rate of remifentanil infusion was used. During the operation, a heart rate of less than 50 beats per minute was considered bradycardia and was treated with atropine 0.015 mg/kg. In addition, the remifentanil infusion rate was reduced if MAP fell below 60 mmHg for more than 60 seconds. Patients were evaluated and compared during operation and recovery in terms of hemodynamic parameters, intraoperative bleeding and postoperative complications.
Results: There was no significant difference between the two groups in the changes of hemodynamic parameters during surgery and recovery (P>0.05). The average bleeding volume in the two groups receiving remifentanil 0.15-0.25 mcg/kg/min and 0.25-0.35 mcg/kg/min Remifentanil was 44.25±23.1 and 28.25±15.5 ml, respectively, and the difference between the two groups was significant (P<0.001). According to the surgeon's opinion, intraoperative bleeding in the 0.25-0.35 mcg/kg/min remifentanil group was significantly lower than 0.15-0.25 (P=0.001).
Conclusion: According to the findings of the present study, it seems that the use of 0.25-0.35 min/µg/kg dose of remifentanil compared to 0.15-0.25 min/µg/kg dose, is associated with a significant reduction in bleeding during rhinoplasty, and also the use of this dose is not associated with the occurrence of serious hemodynamic disorders, including bradycardia and severe drop in blood pressure.

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