Abstract:
After the use of remifentanil, patients consistently complain
of serious pain shortly after the operation. In the current study, an analgesic
dose of a mu-agonistic opioid was given at the beginning of anaesthesia.
Only nitrous oxide and cisatracurium were added for anaesthesia purposes
after induction. This regimen enabled a later use of remifentanil, a reduced
rate during the operation as compared to other publications, earlier recovery
from muscular relaxation and little painful problems after emergency of
anaesthesia. In a study on 24 patients, 15 mg piritramid was given with
the induction of anaesthesia. Average intraoperative administrations of
0.14 µg/kg/min remifentanil were found,
as compared to maintainance doses of 0.2-1.0 µg/kg/min
usually reported in the literature. Rather than letting a new drug fall
into disuse due to an erroneous recommendation, it is recommended to supply
with an additional but long-acting opioid at the beginning of operation,
which will reduce the costs of remifentanil infusion and simultaneously
largely solve the problem with postoperative pain
| Duration and dosage | Mean ± SD | Minimum | Maximum | Unit |
| Anaesthesia induction
to remifentanil start |
20.1 ± 7.6 | 8 | 40 | min |
| Remifentanil start to
begin of operation |
3.7 ± 2.9 | -2 | 28 | min |
| End of remifentanil
until end of operation |
3.7 ± 2.9 | 0 | 13 | min |
| End of remifentanil
until extubation |
9.5 ± 3.8 | 1 | 18 | min |
| Minimal dosage | 0.097 ± 0.042 | 0.000 | 0.150 | µg/kg/min |
| MMD* | 0.143 ± 0.041 | 0.092 | 0.242 | µg/kg/min |
| Maximal (terminal) dosage | 0.185 ± 0.055 | 0.100 | 0.300 | µg/kg/min |
Table 1: Results of the study. * MMD: Mean Maintainance-Dosage.
| MMD | Ref. | Simultaneous anaesthetics used |
| 0.025-2.0 | 7 | N2O, (isoflurane) |
| 0.49 | 8 | N2O |
| 1.00 | 9 | N2O |
| 0.25 | 10 | propofol 0.1 mg/kg/min or isoflurane 0.6% |
| 0.50 | 11 | N2O, propofol |
| 0.20 | 12 | N2O, (isoflurane) |
| 0.25-4.00 | 13 | propofol 0,075 mg/kg/min |
| 0.25-0.50 | 14 | isoflurane 0.5% |
| 0.14 | currrent
study |
N2O, piritramid |
Table 2: Mean Maintainance-Dosage
(MMD) of remifentanil in µg/kg/min utilized for operations in previous
publications (all without previous opioid administration, ref. obtainable
upon request) and current study for comparison.
The current study has not been published
