Alternatives to remifentanil for the analgesic component of total intravenous anaesthesia: a narrative review.

Autor: Hughes LM; Department of Anaesthesia, Critical Care and Pain Medicine, Tallaght University Hospital, Dublin, Ireland., Irwin MG; Department of Anaesthesiology, University of Hong Kong, Hong Kong Special Administrative Region, China., Nestor CC; Department of Anaesthesia, Critical Care and Pain Medicine, Tallaght University Hospital, Dublin, Ireland.
Jazyk: angličtina
Zdroj: Anaesthesia [Anaesthesia] 2023 May; Vol. 78 (5), pp. 620-625. Date of Electronic Publication: 2022 Dec 23.
DOI: 10.1111/anae.15952
Abstrakt: Propfol-remifentanil-based total intravenous anaesthesia has dominated recent clinical practice due to its favourable pharmacokinetic profile. Interruption in remifentanil supply has presented an opportunity to diversify or even avoid the use of opioids and consider adjuncts to propofol-based total intravenous anaesthesia. Propofol, while a potent hypnotic, is not an effective analgesic. The administration of opioids, along with other adjuncts such as α-2 adrenoceptor agonists, magnesium, lidocaine, ketamine and nitrous oxide provide surgical anaesthesia and avoids large doses of propofol being required. We provide an overview of both target-control and manual infusion regimes for the alternative opioids: alfentanil, sufentanil and fentanyl. The optimal combination of hypnotic-opioid dose, titration sequence and anticipated additional postoperative analgesia required depend on the chosen combination. In addition, we include a brief discussion on the role of non-opioid adjuncts in total intravenous anaesthesia, suggested doses and expected reduction in propofol dose.
(© 2022 Association of Anaesthetists.)
Databáze: MEDLINE
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