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A low-dose remifentanil infusion is well tolerated for sedation in mechanically ventilated, critically-ill patients

[La perfusion d’une faible dose de rémifentanil est bien tolérée comme sédation chez des malades gravement atteints, ventilés mécaniquement]

From the Institute of Anaesthesia and Intensive Care, Università Cattolica del Sacro Cuore, Rome, Italy.

Address correspondence to: Dr. Franco Cavaliere, Institute of Anaesthesia and Intensive Care, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1 00168 Rome, Italy. Phone: ++39-06-30154386; Fax: ++39-06-3013450; E-mail: f.cavaliere{at}rm.unicatt.it

Purpose: To study the analgesic and sedative effects of remifentanil in critically-ill patients.

Methods: Remifentanil infusion was started at 0.02 µg•kg^-1•min^-1 in ten mechanically ventilated critically-ill patients, and the infusion rate was increased to 0.05, 0.10, 0.15, 0.20, and 0.25 µg•kg^-1•min^-1 every 30 min. Basally and 25 min after each increase we measured: the Ramsey sedation score (RSS) and the respiratory response subscore of comfort scale (CSRR); the bispectral index (BIS) before and after lightly touching tracheal mucosa; heart rate and systemic arterial pressure; respiratory variables; plasma epinephrine and norepinephrine levels.

Results: Infusion rates up to 0.05 µg•kg^-1•min^-1 were effective against agitation and achieved a good degree of adaption to the respirator in all patients (RSS 2 or more and CSRR 3 or less); BIS decreased significantly; respiratory and circulatory variables were unaffected; mean plasma epinephrine levels decreased. At infusion rates higher than 0.05 µg•kg^-1•min^-1 RSS but not BIS decreased further and patient arousability caused by noxious stimuli was not prevented; respiratory drive suppression occurred at the infusion rates higher than 0.05 µg•kg^-1•min^-1 in four patients; bradycardia and arterial hypotension was observed in three patients; plasma epinephrine levels decreased significantly, while norepinephrine was unaffected; severe itching was experienced by one patient.

Conclusions: Low doses of remifentanil (up to 0.05 µg•kg^-1•min^-1) can be useful in critically-ill patients in order to achieve calm and sedation. Higher doses can inhibit respiratory drive and require controlled mechanical ventilation.

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