Effects Of Remifentanil Research Articles

Fentanyl versus Remifentanil for Cough Suppression and Recovery after Video-Assisted Thoracic Surgery.

BackgroundVarious methods have been used to reduce postoperative pain after thoracic surgery. However, these methods may affect the patient’s respiratory response and delay recovery from anesthesia. We aimed to evaluate the effects of fentanyl and remifentanil during extubation after video-assisted thoracic surgery (VATS).MethodsThis study included 45 randomly-selected male patients who underwent VATS for pneumothorax between July 2011 and August 2012. We divided the participants into 3 groups the F group, which received a bolus injection of 1.0 µg/kg of fentanyl; the R1 group, which received a 0.04 µg/kg/min remifentanil infusion; and the R2 group, which received a 0.08 µg/kg/min remifentanil infusion. Hemodynamics, pain, cough, consciousness level, and nausea were assessed for each group.ResultsThe number and severity of coughs were lower in the R1 and R2 groups than in the F group, and there were no differences between the R1 and R2 groups. Respiratory depression and loss of consciousness were not observed in any of the patients, and there were no differences in hemodynamics.ConclusionIn comparison with fentanyl, remifentanil did not result in a wide fluctuation of blood pressure and heart rate upon emergence from general anesthesia. Moreover, remifentanil contributed to cough suppression and postoperative pain control. Remifentanil seems to be a safe and effective analgesic after VATS.

Comparison of the Effect of Dexmedetomidine and Remifentanil on Pain Control After Spinal Surgery: A Double-Blind, Randomized Clinical Trial.

BackgroundA variety of spinal surgery procedures are performed on patients with different cardiac, vascular, and respiratory comorbidities. Postoperative pain management is a major determinant of hemodynamic and respiratory status in these patients and promotes clinical results, prevents complications, saves health services, and improves the quality of life of patients.ObjectivesWe compared the effects of dexmedetomidine and remifentanil on pain control after spinal surgery.MethodsSixty patients aged 18 - 65 years undergoing spinal surgery were randomized into the two groups of dexmedetomidine and remifentanil. The dexmedetomidine group (group D, n = 30) received dexmedetomidine infusion (0.6 mcg/kg/h), and the remifentanil group (group R, n = 30) received remifentanil infusion (0.1 mcg/kg/min) from induction of anesthesia until extubation. Propofol (1.5 mg/kg) and fentanyl (2mcg/kg) were used to initiate anesthesia, and propofol (100 - 150 mcg/kg/min) was infused to maintain anesthesia. Postoperative pain, hemodynamic parameters, and recovery characteristics were evaluated after surgery.ResultsThe mean pain intensity in the dexmedetomidine group was significantly lower than in the remifentanil group (2.98 ± 1.29 vs. 3.80 ± 1.1; P < 0.001). Hemodynamic changes in the dexmedetomidine group (MAP: 92.60 ± 5.56, HR: 73.07 ± 7) were less, and their condition was significantly more stable than in the remifentanil group (MAP: 93.85 ± 4.78, HR: 79.15 ± 7.03; P < 0.05). The mean arterial oxygen saturation (O2 sat) in the dexmedetomidine group was significantly higher and more stable than in the remifentanil group (98.87 ± 0.51 vs. 97.92 ± 0.46; P < 0.05). The incidence of nausea and vomiting was significantly lower in the dexmedetomidine group compared to the remifentanil group (P < 0.05). The administration of analgesics in the post-anesthetic care unit (PACU) was significantly higher in the remifentanil group than the dexmedetomidine group (P = 0.016).ConclusionsAnesthetic maintenance with either dexmedetomidine or remifentanil infusion until extubation provided more smooth and hemodynamically stable conditions, without complications. However, dexmedetomidine provides better analgesia, causes a more stable hemodynamic state, and reduces postoperative nausea-vomiting, shivering, and the need for analgesics.

Remifentanil provides an increased proportion of time under light sedation than fentanyl when combined with dexmedetomidine for mechanical ventilation

ObjectiveTo compare the effects of remifentanil versus fentanyl during light sedation with dexmedetomidine in adults receiving mechanical ventilation (MV) in the intensive care unit.MethodsIn this retrospective cohort study, we compared the use of remifentanil versus fentanyl in adults receiving MV with dexmedetomidine sedation. The primary outcome was the proportion of time under light sedation (Richmond Agitation–Sedation Scale score between −1 and 0) during MV.ResultsWe included 94 patients and classified 58 into the remifentanil group and 36 into the fentanyl group. The mean proportion of time under light sedation during MV was 66.6% ± 18.5% in the remifentanil group and 39.9% ± 27.3% in the fentanyl group. In the multivariate analysis with control for confounding factors, patients in the remifentanil group showed a significantly higher proportion of time under light sedation than patients in the fentanyl group (mean difference: 24.3 percentage points; 95% confidence interval: 12.9–35.8).ConclusionsRemifentanil use might increase the proportion of time under light sedation in patients receiving MV compared with fentanyl administration.

Remifentanil injected during analepsia shortens length of postanesthesia care unit stay in patients undergoing laparoscopic surgery for endometrial cancer: a randomized controlled trial.

To guarantee efficient operating room (OR) activity, tracheal extubation is often performed in the postanesthesia care unit (PACU). Therefore, the ability of PACU to accommodate postoperative patients is crucial. Optimizing extubation management may speed up the turnover of PACU beds. The aim of the present study was to investigate the effect of remifentanil, which is used during analepsia, on the length of PACU stay in patients undergoing laparoscopic surgery for endometrial cancer. In this prospective trial, we recruited a total of 99 patients, who were scheduled for laparoscopic surgery for endometrial cancer. At the end of the surgery, all patients were immediately transferred to the PACU and continued mechanical ventilation. Upon PACU admission, sputum aspiration was routinely performed. If the hemodynamic parameters fluctuated >30% of the baseline level, or patients moved unconsciously without reaching the criteria of extubation, a bolus injection of either 1 μg/kg remifentanil (Rem group, n=51) or propofol 1.0 mg/kg (Pro group, n=48) was randomly administered. The primary outcome was the duration of PACU stay. The secondary outcomes included time to respiratory breath recovery and time to extubation, along with bispectral index (BIS) values and hemodynamic status after remifentanil or propofol intervention. Times of repeated intervention, rescue administration of vasoactive drugs, and the incidence of adverse events were recorded. Visual analog scale and satisfaction scores at the time of PACU discharge were also evaluated. The duration of PACU stay was shorter in the Rem group than in the Pro group [49 (46.47-51.06 minutes) vs. 62 minutes (60.75-69.29 minutes), P<0.0001]. Compared with the Pro group, the time to spontaneous breathing recovery, the time to extubation, and the incidence of hypoxemia after extubation were reduced in the Rem group (P<0.0001, P<0.0001, P=0.03, respectively). After anesthetic administration, the BIS value decreased less in the Rem group (P<0.0001); blood pressure and heart rate (HR) declined, but were comparable in both groups. Remifentanil, which is injected during analepsia, significantly shortens the duration of PACU stay without increasing adverse events in the peri-extubation period.

Comparison of the Effect of Dexmedetomidine and Remifentanil on Controlled Hypotension During Rhinoplasty: A Clinical Trial Study.

One of the most important problems during cosmetic nose surgery is excessive bleeding. Controlled hypotension is an appropriate technique for reducing intraoperative bleeding as well as satisfactory and non-bloody surgical field. Different drugs, such as dexmedetomidine and remifentanil, are used to control hypotension. The aim of this study was to compare the effect of dexmedetomidine and remifentanil on the creation of control hypotension during rhinoplasty. This study is a randomized, double-blind clinical trial which was performed on 60 patients randomly divided into two groups D (Dexmedetomidine) and R (Remifentanil). In group D (0.5 mg / kg / h) Dexmedetomidine infusion and in group R (50-100 μg / kg / h) Remifentanil infusion. The study groups were compared in terms of hemodynamics and intraoperative bleeding. The data obtained from completed questionnaires were analyzed using SPSS software, T-test and ANOVA statistical tests and were presented in tables and statistical charts. The results of this study showed that the mean MAP (Mean Arterial Pressure) was significantly lower in remifentanil group patients than in dexmedetomidine group, while the intraoperative bradycardia rate was different at various time. During rhinoplasty surgery, both dexmedetomidine and remifentanil were effective in controlling hypotension and reducing intraoperative bleeding, but the effect of remifentanil was more pronounced than dexmedetomidine.

Effects of remifentanil/histamine mixtures in rats responding under a choice procedure.

Intravenous drug self-administration remains the 'gold standard' for assessing abuse liability. Failure of a drug to maintain self-administration might indicate the absence of positive reinforcing effects but might also indicate the presence of aversive effects. Sensitivity to aversive and punishing effects of drugs (as well as nondrug stimuli) might collectively determine the likelihood of use, abuse and relapse. Using a choice procedure, this study compared the effects of remifentanil (mu opioid receptor agonist; 0.001-0.01 mg/kg/infusion) and histamine (H1-4 receptor agonist; 0.32-3.2 mg/kg/infusion), alone and in mixtures, to test the hypothesis that remifentanil/histamine mixtures are less reinforcing compared with remifentanil alone and less punishing compared with histamine alone. Male Sprague-Dawley rats (n = 10) chose between an intravenous infusion + a pellet and a pellet alone. Rats were indifferent to saline, chose remifentanil + a pellet over a pellet alone, and chose a pellet alone over histamine + a pellet. The effects of remifentanil/histamine mixtures generally were different from the constituent doses of histamine alone but not from remifentanil alone. A mixture containing 3.2 mg/kg/infusion histamine and either 0.001 or 0.0032 mg/kg/infusion remifentanil was not different from saline but was different from the effects of the constituent dose, insofar as choice increased compared with 3.2 mg/kg/infusion histamine alone and decreased compared with 0.001 or 0.0032 mg/kg/infusion remifentanil alone. Reinforcing doses of remifentanil combined with punishing doses of histamine can yield mixtures that are neither preferred nor avoided, offering 'proof-of-principle' for using drug mixtures to avoid adverse effects of opioid receptor agonists.

The Effects of Remifentanil and Fentanyl on Human Heart Rate and Blood Pressure under General Anesthesia

全身麻酔下にレミフェンタニル（RF）とフェンタニル（F）を約3ng/mLの効果部位濃度で維持し，血圧低下・徐脈作用を比較した．80名を対象とし，無作為にRF群，F群の2群に分けた．心拍数（HR），収縮期血圧（SBP），拡張期血圧（DBP），平均血圧（MBP）の最大低下率（％）は，RFではそれぞれ20.3±15.9，39.5±12.8，35.0±12.2，35.7±12.1％，Fでは19.2±15.8，34.9±11.8，28.4±11.7，29.7±11.1％（M±SD）であった．除脂肪体重，年齢，フェニレフリン，アトロピンの影響を精査した結果，RF群とF群で有意差はないと考えられた．

Effects of Remifentanil on Cardiovascular Stimulation Caused by Local Anesthetic With Epinephrine: A Power Spectral Analysis.

The objectives of this research were to investigate (a) what was the most effective infusion rate of remifentanil and (b) the degree to which sympathomimetic effects were involved with cardiovascular stimulation by using a power spectral analysis of heart rate variability (HRV). A total of 63 healthy individuals scheduled for sagittal split ramus osteotomy were enrolled and randomly allocated to 1 of 3 groups: remifentanil infusion rate of 0.1, 0.2, or 0.4 μg/kg/min. Anesthesia was maintained with remifentanil and propofol. Before the surgical procedure, 2% lidocaine containing 12.5 μg/mL epinephrine was administered in the surgical field for local anesthesia. Systolic blood pressure (SBP), heart rate (HR), low-frequency (LF) and high-frequency (HF) components in HRV power spectral analysis, and the LF/HF ratio were analyzed. Increases in SBP and HR were observed after local anesthesia in all 3 groups, but no significant differences were observed between the groups. Remifentanil infusion at 0.1 μg/kg/min may be appropriate to minimize cardiovascular stimulation caused by exogenous epinephrine from local anesthesia. Although a rise in the LF/HF ratio was observed after local anesthesia in all groups, no relationship was observed between the cardiovascular changes and the increase in LF/HF ratio. This suggests that sympathomimetic effects are involved to a lesser extent with the cardiovascular stimulation caused by exogenous epinephrine.

Application of Remifentanil in Analgesia and Sedation of Mechanically Ventilated Patients in Intensive Care Unit

To observe the analgesic and sedative effect of remifentanil in patients with mechanical ventilation in intensive care unit and to explore the application value of remifentanil in intensive care unit patients with mechanical ventilation. 164 patients were randomly divided into remifentanil combined with dexmedetomidine group (R group), sufentanil combined with dexmedetomidine group (S group) where 82 patients in each group. The patients in the two groups were assessed with the pain observation instrument of intensive care (critical care pain observation tool) for analgesia score and the sedative effect was assessed with the Ramsay scale. The vital signs during the treatment, the time for patients to achieve satisfactory analgesia and sedation, the time for mechanical ventilation, the time for intensive care unit hospitalization and the occurrence of adverse reactions were recorded respectively. Both groups of patients can achieve satisfactory analgesic and sedative effect. Critical care pain observation tool score of patients in the two groups was significantly lower than that before treatment (p<0.05), the percentage of Ramsay assessment grade 3-4 of patients in the R group was significantly higher than that in the S group. Heart rate, map of mean arterial pressure and autonomic respiratory rate of patients in the two groups were significantly lower than that before treatment (p<0.05). There was no significant difference in heart rate between the two groups (p>0.05), map of mean arterial pressure of patients in the R group was significantly higher than that in the S group immediately after treatment (p<0.05); respiratory rate in R group was significantly lower than that in S group (p<0.05). The time of analgesia and sedation (min), mechanical ventilation (H) and intensive care unit hospitalization (H) in group R were significantly shorter than that in group S (p<0.05). The number of hypotension patients in R group was more than that in S group and delirium and agitation were lower than those in S group (p<0.05). Remifentanil combined with dexmedetomidine can rapidly achieve the goal of analgesia and sedation, improve vital signs and shorten the time of satisfactory analgesia and sedation, mechanical ventilation, hospital stay and no serious adverse reactions.

Pediyatrik Kalp Cerrahisi Anestezisinde Remifentanil ve Fentanilin İntraoperatif Hemodinamik Etkilerinin Karşılaştırılması

Objective: The aim of this prospective observational study was to compare the hemodynamic effects of remifentanil and fentanyl, which are used as intraoperative analgesics in pediatric cardiac surgery. Methods: Patients were divided into two groups as those who received continuous intravenous remifentanil infusion (Group R) or intermittent intravenous fentanyl for intraoperative analgesia (Group F). These groups were compared in terms of hemodynamic characteristics and intraoperative complications. Results: The most common congenital cardiac pathology observed in the patients included in the study was ventricular septal defects (32%). Intraoperative complications occurred in 21 (40%) patients, and ventricular fibrillation was the most common complication (n=6; 11.5%). When the patients in both groups were compared in terms of intraoperative hemodynamic indicators, the mean arterial pressure values of the patients in Group R after sternotomy were significantly lower than those of the patients in Group F (p=0.034). No statistically significant difference was found between the two groups in terms of other hemodynamic indicators. When the two groups were compared in terms of intraoperative complications, the difference was not statistically significant although the number of patients with complications was higher in Group F (p=0.1). Conclusion: As a result of this study, it was found that remifentanil was as effective as fentanyl in maintaining intraoperative hemodynamic stability in patients undergoing pediatric cardiac surgery.

Remifentanil protects against myocardial ischemia/reperfusion injury via miR-205-mediated regulation of PINK1.

Myocardial ischemia/reperfusion (I/R) injury could lead to severe cardiovascular ischemic disease, including myocardial infarction and contractile dysfunction. Remifentanil demonstrated protective effect on myocardial I/R injury. The underlying pathophysiological mechanism was then investigated in this study. In the current study, primary cardiomyocytes were isolated from rats, and then preconditioned with remifentanil. Rats, tail vein injected with miR-205 antagomir, were subjected to infusion of remifentanil, and then subjected to regional ischemia followed by reperfusion. The results demonstrated that cell viability of hypoxia/reoxygenation-induced cardiomyocytes was increased post remifentanil, while the apoptosis was decreased accompanied with reduced cleaved caspase-3 expression. Hypoxia/reoxygenation treatment increased miR-205 and decreased PINK1 (PTEN induced putative kinase 1) expression. However, preconditioning with remifentanil reduced miR-205 and enhanced PINK1. Moreover, over-expression of miR-205 decreased PINK1 expression and counteracted the effects of remifentanil-induced increase of cell viability and decrease of cell apoptosis in hypoxia/reoxygenation-induced cardiomyocytes. Injection with miR-205 antagomir improved remifentanil-induced decrease of infarct size and LDH (lactic acid dehydrogenase) activity in rat model with I/R injury. In conclusion, miR-205 might participate in the protective effect of remifentanil in rat myocardial I/R injury via regulation of PINK1, providing a potential target for amelioration of cardiovascular ischemic disease.

Comparison of remifentanil consumption in pupillometry-guided versus conventional administration in children: a randomized controlled trial.

Remifentanil is a commonly used opioid analgesic during anesthesia in children. Objective measurement of pain is required for adequate dosing of remifentanil. We investigated whether pupillometry-guided remifentanil administration can reduce intraoperative consumption of remifentanil in children. We performed a single-blinded, prospective, randomized controlled trial from December 2018 through June 2019. Children who were 3-12 years of age and classified as having an American Society of Anesthesiologists physical status I-II and undergoing elective surgery under general anesthesia were included. Fifty-six fulfilled the inclusion criteria, and fifty-four completed the study. Participants were randomly assigned to either a pupillometry or conventional group. Patients in both groups received target-controlled infusion of remifentanil. In the pupillometry group, the adjustment of the remifentanil effect site concentration was determined by the pupillary diameter, whereas in the conventional group, the adjustment was based on the anesthesiologist's experience. Primary outcome was intraoperative remifentanil consumption, divided by patient weight and infusion time (ng kg-1 min-1). Remifentanil consumption was reduced by 25% in the pupillometry group compared to the conventional group (116.7±56.0 ng kg-1 min-1 vs. 155.8±64.9 ng kg-1 min-1, respectively; P=0.02). There were no differences in intra- and postoperative blood pressure and heart rate. The incidences of postoperative desaturation or nausea/vomiting were not significantly different. Pupillometry-guided remifentanil administration in children undergoing general anesthesia can reduce the intraoperative remifentanil consumption.

Effects of prophylactic atropine on the time to tracheal intubation with the pre-administration of remifentanil.

Pre-administration of remifentanil in target-controlled propofol and remifentanil anaesthesia could prolong the time of onset of muscle relaxation owing to haemodynamic effects, thereby prolonging the time to tracheal intubation. Although the sympatholytic effects of remifentanil result in bradycardia and hypotension, these responses can be attenuated by the administration of atropine. Therefore, we investigated whether prophylactic administration of atropine could prevent the prolongation of the time to tracheal intubation. Sixty-four patients were included in this study. They were randomised into Group A (atropine 0.5mg, n=32) and Group S (saline 0.9%, n=32), immediately before the pre-administration of remifentanil. The primary outcome was the time to tracheal intubation and the secondary outcomes were rocuronium onset time, time to loss of consciousness (LOC), time to reach a value of 60 on the bispectral index (BIS) and haemodynamic variables. The median [Interquartile range] of the time to tracheal intubation was 240 [214, 288]s in Group S and 190 [176, 212]s in Group A(median difference: 50s, 95% confidence interval: 27-80s, P=.001). Rocuronium onset time was significantly decreased in Group A compared to that in Group S (129 [110, 156] vs 172 [154, 200], P=.001). The times to LOC and reach 60 on the BIS were not significantly different between the two groups. Cardiac output(CO) and heart rate were less decreased in Group A than in Group S (P=.02, P<.001, respectively). Prophylactic administration of atropine could compensate for the reduction in CO in cases pre-administered with remifentanil in target-controlled propofol and remifentanil anaesthesia. This in turn prevented the prolongation of rocuronium onset time and reduced the time to tracheal intubation.

An approach to using pharmacokinetics and electroencephalography for propofol anesthesia for surgery in infants

Safe and effective techniques for propofol total intravenous anesthesia (TIVA) in infants are not well imbedded into clinical practice, resulting in practitioner unfamiliarity and potential for over- and under-dosing. In this education article, we describe our approach to TIVA dosing in infants and toddlers (birth to 36months) which combines the use of pharmacokinetic models with EEG multi-parameter analysis. Pharmacokinetic models describe propofol and remifentanil effect site concentrations (Ce) over time in different age groups for a given dosing regimen. These models display substantial biological variability between individuals within age groups, impeding their application to clinical practice. Nevertheless, they reveal that younger infants require a higher propofol loading dose, a lower propofol maintenance dose, and a higher remifentanil dose compared with older infants. Proprietary EEG indices (eg, Bispectral Index) can serve as a biomarker of propofol Ce in adults and children to guide dosing to the individual patient; however, they are not recommended for infants as their validity remains uncertain this population. In our experience, EEG waveforms and processed parameters can reflect propofol Ce in infants, reflected by spectral edge frequency (SEF), density spectral array (DSA), and waveform patterns. In our practice, we use a "lookup table" of age-based dosing regimens or target-controlled infusion (TCI) based on the pharmacokinetic models to deliver a target propofol Ce and co-administer remifentanil and/or regional technique for analgesia. We analyze Electroencephalogram (EEG) waveforms, SEF, and DSA to adjust the propofol dose or TCI target concentration to the individual infant. EEG analysis mitigates against biological variability inherent in the pharmacokinetic models and has improved our experience with TIVA for infants.

Unanticipated Asystole During Maxillofacial Surgery Due to Activation of the Trigeminocardiac Reflex: What are the Modulating Effects of Intravenous Ketamine and Remifentanil?

Unanticipated Asystole During Maxillofacial Surgery Due to Activation of the Trigeminocardiac Reflex: What are the Modulating Effects of Intravenous Ketamine and Remifentanil?

Effects of isoflurane, remifentanil and dexmedetomidine on selected EEG parameters derived from a Narcotrend Monitor before and after nociceptive stimulation at different MAC multiples in cats

BackgroundThe aim of this prospective and complete cross-over study was to evaluate the effects of isoflurane, remifentanil and dexmedetomidine on EEG parameters derived from the Narcotrend® Monitor before and after nociceptive stimulation at different isoflurane MAC (minimal alveolar concentration) multiples. Seven adult European Domestic Short Hair cats were used. Each cat went through 3 experimental treatments. Group I received isoflurane, group IR received isoflurane and a constant rate infusion (CRI) of remifentanil (18 μg/kg/h IV), and group ID received isoflurane and a CRI of dexmedetomidine (3 μg/kg/h IV). The isoflurane MAC in each group was determined via supramaximal electrical stimulation. The EEG parameters were derived by a Narcotrend Monitor at specific time points before and after nociceptive stimulation at 0.75, 1.0 and 1.5 MAC.The depth of anaesthesia was also assessed by a clinical score.ResultsThe mean MAC sparing effects in group IR and group ID were 9.8 and 55.2%, respectively. The best correlation of EEG and MAC multiples was found for the Narcotrend Index (NI) in group I (r = − 0.67). The NI was also able to differentiate between 0.75 MAC and 1.5 MAC in group IR. Spectral edge frequency had a lower correlation with MAC multiples in group I (r = − 0.62) but was able to differentiate between 0.75 MAC and 1.5 MAC in groups I and IR, and between 1.0 MAC and 1.5 MAC in group IR. Narcotrend Index, SEF 95 and MF increased significantly after nociceptive stimulation at 1.0 MAC in group I, and SEF 95 increased significantly at 0.75 MAC in group ID. The clinical score correlated closer than any of the EEG parameters with MAC in all groups, with highest correlation values in group I (r = − 0.89). Noxious stimulation led to a significant increase of the clinical score at 0.75 MAC and 1.0 MAC in group I.ConclusionsThe EEG parameters derived from the Narcotrend Monitor show correlation to isoflurane MAC multiples in cats, but the anaesthetic protocol and especially the addition of dexmedetomidine have great influence on the reliability. The Narcotrend Monitor can be used as an additional tool to assess anesthetic depth in cats.

The effect of dexmedetomidine and remifentanil on the postoperative sore throat after thyroidectomy.

Background:Postoperative sore throat (POST) is an important concern in surgical patients undergoing endotracheal intubation. Its prevalence after thyroidectomy is up to 80%. The current study aimed to assess the effect of dexmedetomidine and remifentanil on postoperative sore throat.Methods:Seventy-four patients who underwent thyroidectomy were randomized to receive either dexmedetomidine (group D) or remifentanil (group R). At anesthesia induction, group D received dexmedetomidine 1 μg/kg over 10 minutes, followed by continuous dexmedetomidine infusion at 0.3 to 0.6 μg/kg/hour during surgery. Group R received remifentanil of 3 to 4 ng/ml during induction, followed by 1.5 to 2.5 ng/ml remifentanil infusion during surgery. POST at rest and swallowing was assessed during the first 24 hours in serial time periods (0–1, 1–6, and 6–24 hours). Hoarseness and postoperative pain score were also assessed.Results:POST incidence at rest (0–1, 1–6, and 6–24 hours) and swallowing (1–6 and 6–24 hours) was lower in group D than in group R. POST severity was significantly lower in group D than in group R during each time period. The incidence of postoperative hoarseness was also lower in group D than in group R at 1 to 6 and 6 to 24 hours. The postoperative pain score was lower in group D than in group R during each time period.Conclusion:Intraoperative dexmedetomidine infusion reduced the incidence and severity of POST for 24 hours after thyroidectomy.

Study on the Clinical Effect of Dezocine and Remifentanil Combined with Propofol in Anesthesia for Painless Abortion

Objective: To investigate the anesthetic effect of dezocine and remifentanil combined with propofol in painless artificial abortion. Methods: 90 cases in total of painless induced abortion in our hospital from May 2017 to May 2020 were retrospectively analyzed, 29 cases of propofol anesthesia (group A), 29 cases of dezocine combined with propofol anesthesia (group B), and 32 cases of remifentanil combined with propofol anesthesia (group C) were compared the anesthesia situation. Results: Compared with the cases in group A, the incidence of pain, body movement and SPO2&lt;90% at the injection site were lower in group B and group C, the use of propofol was reduced, and the VAS scores were lower when the patients begin to awake, and the efficiency was higher than that in group A(P&lt;0.05); there was no statistic difference in the changes of SBP, DBP and HR index data in the operation time, postoperative awake time, and preoperative, intraoperative and postoperative time points of the three groups(P&gt;0.05). Conclusion: Dezocine and remifentanil combined with propofol for painless artificial abortion anesthesia has more significant effect than propofol anesthesia alone, which can relieve patients' pain and reduce the chance of respiratory depression.

Comparison between Effects of Ketamine and Remifentanil Used During Oocyte Retrieval on ICSI Outcome

Background: A number of experimental as well as human studies documented the existence of anesthetic agents in the follicular fluid with possible adverse effects on the oocyte quality and subsequent fertilization and implantation; however, data about ketamine are lacking. Controversial data has emerged with some favors the existence of variation in fertility parameters and others deny such an association. Objective: Is to compare the effect of drugs used for general anesthesia during oocyte retrieval (ketamine vs remifentanil) on ICSI outcome Patients and methods: The current prospective comparative study has been carried out at the infertility center of “High Institute of Infertility Diagnosis and Assisted Reproductive Technologies /Reproductive Physiology/Al- Nahrain University/ Baghdad/ Iraq” form July 2019 through April 2020. The study included 60 infertile women undergoing intracytoplasmic sperm injection (ICSI) with a variety of causes of infertility with an age range of 19 to 44. Those patients were categorized into two groups according to anesthetic regimen introduced during general anesthesia for oocyte retrieval. The first group received ketamine, midazolam and propofol while the second group received remifentanil, midazolam and propofol. Results: the results of present study showed that remifentanil resulted in higher fertilization rate than ketamine in a highly significant manner (P < 0.01); however, cleavage rate was comparable in both groups. There was significant difference (p 0.05). A cutoff value of recovery time of ≤ 10 minutes resulted in a 80 % sensitivity and 65 % specificity in predicting positive pregnancy outcome. Conclusion: Remifentanil is superior to ketamine in routine general anesthesia procedures for ova pickup in IVF/ICSI procedures because of significantly higher fertilization rate, pregnancy rate and shorter recovery time.

Analgesic Effects of Dexmedetomidine and Remifentanil in Patients with Herniated Disc

Analgesic Effects of Dexmedetomidine and Remifentanil in Patients with Herniated Disc