Laura Ruggeri1, Giovanni Landoni1, Fabio Guarracino2, Sabino Scolletta3, Elena Bignami1, Alberto Zangrillo1
1 Department of Anesthesia and Intensive Care Medicine, Universitą Vita-Salute San Raffaele, Milan, Italy
2 Department of Cardiothoracic, Cardiothoracic Anesthesia and Intensive Care Medicine, University Hospital of Pisa, Pisa, Italy
3 Department of Surgery and Bioengineering, Unit of Cardiothoracic Anesthesia and Intensive Care, University of Siena, Siena, Italy
Remifentanil has a unique pharmacokinetic profile, with a rapid onset and offset of action and a plasmatic metabolism. Its use can be recommended even in patients with renal impairment, hepatic dysfunction or poor cardiovascular function. A potential protective cardiac preconditioning effect has been suggested. Drug-related adverse effects seem to be comparable with other opioids. In cardiac surgery, many randomized controlled trials demonstrated that the potential benefits of the use of remifentanil not only include a profound protection against intraoperative stressful stimuli, but also rapid postoperative recovery, early weaning from mechanical ventilation, and extubation. Remifentanil shows ideal properties of sedative agents being often employed for minimally invasive cardiologic techniques, such as transcatheter aortic valve implantation and radio frequency treatment of atrial flutter, or diagnostic procedures such as transesophageal echocardiography. In intensive care units remifentanil is associated with a reduction in the time to tracheal extubation after cessation of the continuous infusion; other advantages could be more evident in patients with organ dysfunction. Effective and safe analgesia can be provided in case of short and painful procedures (i.e. chest drain removal). In conclusion, thanks to its peculiar properties, remifentanil will probably play a major role in critically ill cardiac patients.
Department of Cardiothoracic Anesthesia and Intensive Care, Istituto Scientifico San Raffaele, Via Olgettina 60, Milan, 20132
Source of Support: None, Conflict of Interest: None
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