• Franco Cavaliere, Massimo Antonelli, Andrea Arcangeli, Giorgio Conti, Roberta Costa, Mariano Alberto Pennisi, and Rodolfo Proietti.
• Institute of Anaesthesia and Intensive Care, Università Cattolica del Sacro Cuore, Rome, Italy. f.cavaliere@rm.unicatt.it
• Can J Anaesth. 2002 Dec 1;49(10):1088-94.

PurposeTo study the analgesic and sedative effects of remifentanil in critically-ill patients.MethodsRemifentanil infusion was started at 0.02 microg x kg(-1) x 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 microg x kg(-1) x 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.ResultsInfusion rates up to 0.05 microg x kg(-1) x 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 microg x kg(-1) x 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 microg x kg(-1) x 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.ConclusionsLow doses of remifentanil (up to 0.05 microg x kg(-1) x 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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