Effect of remifentanil on the recovery profile after head and neck surgeries: A prospective study
Background and Aims: Development of opioid tolerance in the perioperative period due to remifentanil remains controversial. We evaluated occurrence of opioid tolerance and other adverse effects due to remifentanil in patients undergoing head and neck surgery. Material and Methods: We recruited adul...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2018-01-01
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| Series: | Journal of Anaesthesiology Clinical Pharmacology |
| Subjects: | |
| Online Access: | http://www.joacp.org/article.asp?issn=0970-9185;year=2018;volume=34;issue=3;spage=307;epage=313;aulast=Suhitharan |
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| author | Thangavelautham Suhitharan Sudhakar Subramani Ma Thin Mar Win Widyawaty Binte Sulaiman Nurain Binte Johar Ong Biauw Chi |
| author_facet | Thangavelautham Suhitharan Sudhakar Subramani Ma Thin Mar Win Widyawaty Binte Sulaiman Nurain Binte Johar Ong Biauw Chi |
| author_sort | Thangavelautham Suhitharan |
| collection | DOAJ |
| description | Background and Aims: Development of opioid tolerance in the perioperative period due to remifentanil remains controversial. We evaluated occurrence of opioid tolerance and other adverse effects due to remifentanil in patients undergoing head and neck surgery.
Material and Methods: We recruited adult participants with ASA status I to III who received general anesthesia for approximately 2 h for elective head and neck procedures. Remifentanil infusion was used in one group and intermittent boluses of morphine or fentanyl were administered in another group. Postoperative pain was treated with intermittent boluses of morphine and fentanyl in post-anaesthesia care unit (PACU) to achieve a numerical rating scale score of 3. Opioid requirement was assessed as an indicator of opioid tolerance. Patients were also evaluated for time to discharge from PACU.
Results: We studied 222 adults aged between 21 and 80 years. One hundred and eleven patients received a combination of remifentanil infusion and morphine boluses, and another 111 patients received only fentanyl and/or morphine boluses intraoperatively. Fifty-one patients in the remifentanil group and 25 in the fentanyl/morphine group required opioids in the PACU. Opioid requirement were significantly more (mean ± SD, 44.98 ± 59.7 Vs 20.23 ± 46.66 mcg.kg−1; P = 0.001) and required longer time to discharge from PACU in the remifentanil group compared to the fentanyl/morphine group (Mean ± SD, 88.6 ± 39.5 min Vs 73.1 ± 38.4 min; P < 0.001). No difference in the incidence of adverse effects in two groups was noted.
Conclusion: At clinically relevant doses, intraoperative remifentanil infusion appears to increase opioid consumption in the immediate postoperative period. This can result in delayed discharge from PACU for patients undergoing elective head and neck procedures. |
| first_indexed | 2024-12-10T23:24:39Z |
| format | Article |
| id | doaj.art-f0041d8dc8ad42f48c93dc25bd2e4f26 |
| institution | Directory Open Access Journal |
| issn | 0970-9185 |
| language | English |
| last_indexed | 2024-12-10T23:24:39Z |
| publishDate | 2018-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Anaesthesiology Clinical Pharmacology |
| spelling | doaj.art-f0041d8dc8ad42f48c93dc25bd2e4f262022-12-22T01:29:37ZengWolters Kluwer Medknow PublicationsJournal of Anaesthesiology Clinical Pharmacology0970-91852018-01-0134330731310.4103/joacp.JOACP_337_16Effect of remifentanil on the recovery profile after head and neck surgeries: A prospective studyThangavelautham SuhitharanSudhakar SubramaniMa Thin Mar WinWidyawaty Binte SulaimanNurain Binte JoharOng Biauw ChiBackground and Aims: Development of opioid tolerance in the perioperative period due to remifentanil remains controversial. We evaluated occurrence of opioid tolerance and other adverse effects due to remifentanil in patients undergoing head and neck surgery. Material and Methods: We recruited adult participants with ASA status I to III who received general anesthesia for approximately 2 h for elective head and neck procedures. Remifentanil infusion was used in one group and intermittent boluses of morphine or fentanyl were administered in another group. Postoperative pain was treated with intermittent boluses of morphine and fentanyl in post-anaesthesia care unit (PACU) to achieve a numerical rating scale score of 3. Opioid requirement was assessed as an indicator of opioid tolerance. Patients were also evaluated for time to discharge from PACU. Results: We studied 222 adults aged between 21 and 80 years. One hundred and eleven patients received a combination of remifentanil infusion and morphine boluses, and another 111 patients received only fentanyl and/or morphine boluses intraoperatively. Fifty-one patients in the remifentanil group and 25 in the fentanyl/morphine group required opioids in the PACU. Opioid requirement were significantly more (mean ± SD, 44.98 ± 59.7 Vs 20.23 ± 46.66 mcg.kg−1; P = 0.001) and required longer time to discharge from PACU in the remifentanil group compared to the fentanyl/morphine group (Mean ± SD, 88.6 ± 39.5 min Vs 73.1 ± 38.4 min; P < 0.001). No difference in the incidence of adverse effects in two groups was noted. Conclusion: At clinically relevant doses, intraoperative remifentanil infusion appears to increase opioid consumption in the immediate postoperative period. This can result in delayed discharge from PACU for patients undergoing elective head and neck procedures.http://www.joacp.org/article.asp?issn=0970-9185;year=2018;volume=34;issue=3;spage=307;epage=313;aulast=SuhitharanHead and neck surgeryopioid toleranceremifentanil |
| spellingShingle | Thangavelautham Suhitharan Sudhakar Subramani Ma Thin Mar Win Widyawaty Binte Sulaiman Nurain Binte Johar Ong Biauw Chi Effect of remifentanil on the recovery profile after head and neck surgeries: A prospective study Journal of Anaesthesiology Clinical Pharmacology Head and neck surgery opioid tolerance remifentanil |
| title | Effect of remifentanil on the recovery profile after head and neck surgeries: A prospective study |
| title_full | Effect of remifentanil on the recovery profile after head and neck surgeries: A prospective study |
| title_fullStr | Effect of remifentanil on the recovery profile after head and neck surgeries: A prospective study |
| title_full_unstemmed | Effect of remifentanil on the recovery profile after head and neck surgeries: A prospective study |
| title_short | Effect of remifentanil on the recovery profile after head and neck surgeries: A prospective study |
| title_sort | effect of remifentanil on the recovery profile after head and neck surgeries a prospective study |
| topic | Head and neck surgery opioid tolerance remifentanil |
| url | http://www.joacp.org/article.asp?issn=0970-9185;year=2018;volume=34;issue=3;spage=307;epage=313;aulast=Suhitharan |
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