Effects Of Remifentanil Research Articles

Comparison of I-Gel insertion conditions with two different induction methods in children: a prospective observational study

Aim: Insufficient depth of anesthesia is one of the important causes of laryngospasm in pediatric patients undergoing surgery. Propofol is a widely used anesthetic agent for induction of anesthesia in children. Its use alone in induction may be insufficient to suppress laryngeal reflexes during laryngeal mask insertion and may lead to complications such as cough, hiccups, and laryngospasm. In this study, the effects of fentanyl-ketamine mixture and remifentanil used as co-induction in anesthesia induction in children on I-gel insertion conditions and hemodynamic stability were compared. In addition, the evaluation of propofol injection pain after the use of coinduction agent was made.
 Material and Method: The study included 60 patients aged 2-10 years, of ASA I-III class, who underwent ambulatory surgery. For anesthesia induction, the KF group (n:30) were administered intravenous (iv) 1 mcg/kg fentanyl + 0.5 mg/kg ketamine followed by 3 mg/kg propofol, and the R group (n:30) were administered iv 0.5 mcg/kg remifentanil followed by 3 mg propofol. The I-gel insertion conditions were evaluated by scoring the six variables of mouth opening, ease of insertion, swallowing, coughing, movement, and laryngospasm. Pain during propofol injection was graded using a four-point scale. 
 Results: No statistically significant difference was determined between the groups in terms of I-gel insertion conditions total score values (p>0.05). The pain of the propofol injection was determined at a significantly higher level in Group R (p

Systematic review of the effectiveness of remifentanil in term breech pregnancies undergoing external cephalic version

BackgroundExternal cephalic version (ECV) is a moderately painful procedure used to turn a fetus from a non-vertex to cephalic position. This systematic review and meta-analysis compared intravenous remifentanil with other analgesia or no analgesia or placebo on the success rate and associated pain of ECV. MethodsSystematic searches for randomised controlled trials using remifentanil during ECV for non-cephalic term singleton pregnancies were conducted in EMBASE, MEDLINE and the Cochrane Library to October 2021. The primary outcomes were successful ECV and maternal pain; secondary outcomes included mode of delivery and adverse effects. The Cochrane Risk of Bias tool was used and meta-analysis undertaken if there were ≥2 comparable studies. ResultsFour trials were identified, three placebo-controlled and one vs no analgesia, totalling 482 participants. Comparisons against nitrous oxide or neuraxial anaesthesia were not analysed. Two studies had a low overall risk of bias, and two had some concern for bias. Remifentanil compared with placebo increased the success of ECV by 43% (risk ratio [RR] 1.43; 95% confidence interval [CI] 1.14 to 1.78). Pain scores (0–10) were lower (mean difference −1.97; 95% CI −2.49 to −1.46) whilst there was no impact on caesarean delivery rate (RR 0.97; 95% CI 0.81 to 1.17). Adverse events were rare, with fetal bradycardia observed less often with remifentanil than placebo. ConclusionsRemifentanil increases the procedural success of ECV and reduces pain compared with placebo. Trials were at low risk of bias and contained a sufficient number of participants to have reasonable confidence in this finding.

Effects of remifentanil on the noxiously stimulated somatosensory evoked potentials recorded at the spinal cord in dogs and cats

This study assessed the somatosensory evoked potentials (SEPs) in dogs and cats to compare the effect of remifentanil on the action potentials evoked by peripheral noxious stimulation in the spinal cord. Five healthy dogs and five healthy cats underwent general anaesthesia induced with propofol and maintained with isoflurane. Each animals received all dosage of a constant-rate infusion of remifentanil at 0 (control), 0.25, 0.5, 1.0 or 2.0 μg/kg/min. The hair of the dorsal foot of a hind limb was clipped and an intraepidermal stimulation electrode that could selectively stimulate the nociceptive Aδ and C fibres was attached. An electrical stimulus was generated by a portable peripheral nerve testing device. The evoked potentials were recorded by two needle electrodes inserted subcutaneously in the dorsal midline between the lumbar vertebra: L3-L4 and L4-L5. Bimodal waveforms were obtained by electrical stimulation in control dogs and cats. The inhibitory effect of remifentanil was evaluated by comparing the changes in the N1P2 and P2N2 amplitudes. The N1P2 amplitude was depressed by remifentanil in a dose-dependent manner in dogs, but it showed no remifentanil-induced changes in cats. While the P2N2 amplitude was also depressed in a dose-dependent manner in dogs, it showed milder remifentanil-induced effects in cats. The N1P2 and P2N2 amplitudes observed herein are assumed to represent the evoked potentials derived from the Aδ and C fibres, respectively. Thus, the inhibitory effect of remifentanil on nociceptive transmission at the spinal cord was much weaker in cats, especially for transmissions possibly derived from Aδ fibres.

A Comparative Study of Hemodynamic Effects of Remifentanil with or without Atropine in Pediatric Day Case Surgery

A Comparative Study of Hemodynamic Effects of Remifentanil with or without Atropine in Pediatric Day Case Surgery

The effects of intravenous remifentanil on umbilical artery serum-derived exosomes in parturients undergoing epidural anesthesia: a randomized trial

BackgroundUmbilical artery serum-derived exosomes (UEs) serve as messengers for maternal–fetal information exchange and cellular regulation. Intravenous remifentanil could be considered as an effective adjunct to epidural anesthesia in providing a favorable analgesia effect for cesarean section (C-section), but its effects on UEs are currently unknown.MethodsFrom 01/12/2021 to 30/06/2022, eligible parturients scheduled for repeated C-section at the First Affiliated Hospital of Wenzhou Medical University were randomized to receive either an intravenous bolus (0.15 μg/kg) followed by a continuous infusion (0.075 μg/kg/min) of remifentanil or normal saline throughout the procedure. The primary outcome was the number of UEs. Secondary outcomes included the size and protein amount of UEs, the vital signs, visceral pain score, sedation score, maternal satisfaction score, Apgar score, the incidence of neonatal asphyxia, umbilical arterial pH, and the presence of complications.ResultsNanoparticle tracking analysis indicated similar size of UEs between the two groups, but the number and protein amount of UEs were increased in the remifentanil group compared to the control group (P < 0.05). In parturients receiving remifentanil, visceral pain scores were decreased, which was accompanied by the increased scores of maternal satisfaction with the anesthetic method (P < 0.05). Other maternal and neonatal outcomes were comparable between the two groups (P > 0.05).ConclusionThe intravenous administration of remifentanil increased the number of UEs in parturients undergoing repeated C-section under epidural anesthesia, with improved birth experience and minimal neonatal complications.

Effect of Remifentanil vs Neuromuscular Blockers During Rapid Sequence Intubation on Successful Intubation Without Major Complications Among Patients at Risk of Aspiration

It is uncertain whether a rapid-onset opioid is noninferior to a rapid-onset neuromuscular blocker during rapid sequence intubation when used in conjunction with a hypnotic agent. To determine whether remifentanil is noninferior to rapid-onset neuromuscular blockers for rapid sequence intubation. Multicenter, randomized, open-label, noninferiority trial among 1150 adults at risk of aspiration (fasting for <6 hours, bowel occlusion, recent trauma, or severe gastroesophageal reflux) who underwent tracheal intubation in the operating room at 15 hospitals in France from October 2019 to April 2021. Follow-up was completed on May 15, 2021. Patients were randomized to receive neuromuscular blockers (1 mg/kg of succinylcholine or rocuronium; n = 575) or remifentanil (3 to 4 μg/kg; n = 575) immediately after injection of a hypnotic. The primary outcome was assessed in all randomized patients (as-randomized population) and in all eligible patients who received assigned treatment (per-protocol population). The primary outcome was successful tracheal intubation on the first attempt without major complications, defined as lung aspiration of digestive content, oxygen desaturation, major hemodynamic instability, sustained arrhythmia, cardiac arrest, and severe anaphylactic reaction. The prespecified noninferiority margin was 7.0%. Among 1150 randomized patients (mean age, 50.7 [SD, 17.4] years; 573 [50%] women), 1130 (98.3%) completed the trial. In the as-randomized population, tracheal intubation on the first attempt without major complications occurred in 374 of 575 patients (66.1%) in the remifentanil group and 408 of 575 (71.6%) in the neuromuscular blocker group (between-group difference adjusted for randomization strata and center, -6.1%; 95% CI, -11.6% to -0.5%; P = .37 for noninferiority), demonstrating inferiority. In the per-protocol population, 374 of 565 patients (66.2%) in the remifentanil group and 403 of 565 (71.3%) in the neuromuscular blocker group had successful intubation without major complications (adjusted difference, -5.7%; 2-sided 95% CI, -11.3% to -0.1%; P = .32 for noninferiority). An adverse event of hemodynamic instability was recorded in 19 of 575 patients (3.3%) with remifentanil and 3 of 575 (0.5%) with neuromuscular blockers (adjusted difference, 2.8%; 95% CI, 1.2%-4.4%). Among adults at risk of aspiration during rapid sequence intubation in the operating room, remifentanil, compared with neuromuscular blockers, did not meet the criterion for noninferiority with regard to successful intubation on first attempt without major complications. Although remifentanil was statistically inferior to neuromuscular blockers, the wide confidence interval around the effect estimate remains compatible with noninferiority and limits conclusions about the clinical relevance of the difference. ClinicalTrials.gov Identifier: NCT03960801.

Retracted: Effects of Remifentanil and Sufentanil Anesthesia on Cardiac Function and Serological Parameters in Congenital Heart Surgery

Retracted: Effects of Remifentanil and Sufentanil Anesthesia on Cardiac Function and Serological Parameters in Congenital Heart Surgery

Remifentanil does not affect human microglial immune activation in response to pro-inflammatory cytokines.

Remifentanil is a potent ultra-short acting μ-opioid analgesic drug, frequently used in anaesthesia due to its favorable pharmacodynamic and pharmacokinetic profile. It may be associated with the occurrence of hyperalgesia. Preclinical studies suggest a potential role of microglia, although the molecular mechanisms have not been fully elucidated. Considering the role of microglia in brain inflammation and the relevant differences among species, the effects of remifentanil were studied on the human microglial C20 cells. The drug was tested at clinically relevant concentrations under basal and inflammatory conditions. In the C20 cells, the expression and secretion of interleukin 6, interleukin 8 and the monocyte chemotactic protein 1 were rapidly induced by a mixture of pro-inflammatory cytokines. This stimulatory effect was sustained up to 24 h. Remifentanil did not exert any toxic effect nor modify the production of these inflammatory mediators, thus suggesting the lack of direct immune modulatory actions on human microglia.

Comparison of the effects of tranexamic acid, nitroglycerin, and remifentanil on the prevention of bleeding during herniated lumbar intervertebral disc surgery: A randomized clinical trial.

Surgery is a well-known and effective method of treating lumbar intervertebral disc herniation. The present study aimed to compare the effects of administering tranexamic acid (TXA), nitroglycerin (NTG), and remifentanil (REF) on hemorrhage prevention during herniated lumbar intervertebral disc surgery. A double-blind clinical trial was conducted on 135 participants undergoing lumbar intervertebral disc surgery. A randomized block design was used for subject assignment to three groups including TXA, NTG, and REF. The hemodynamic parameters, bleeding rate, hemoglobin level, and the amount of infused propofol were measured and recorded after surgery. Data were then analyzed in SPSS software using Chi-square test and analysis of variance. The mean age of participants in the study was 42.12 ± 7.93 years, and all three groups were equal in terms of demographic characteristics (P > 0.05). The mean arterial pressure (MAP) of the TXA and NTG groups was notably higher than the REF group (P < 0.008). The mean heart rate (HR) of the TXA and NTG groups was notably higher than the REF group (P < 0.05). The propofol dosage used in the TXA group was higher than the two groups of NTG and REF (P < 0.001). Among participants undergoing lumbar intervertebral disc surgery, the greatest MAP variability was observed in the NTG group. Higher mean HR and propofol consumption was observed in the NTG and TXA groups when compared to REF. No statistically significant differences were noted between groups in oxygen saturation or bleeding risk. Based on these findings, REF may be considered a preferred surgical adjunct over TXA and NTG during lumbar intervertebral disc surgery.

Retracted: The Effect of Propofol plus Remifentanil for PostoperativePain and Heart Rate Management in Patients Undergoing Abdominal Hysterectomy.

[This retracts the article DOI: 10.1155/2022/7646361.].

Comparing the bleeding control effect of labetalol, remifentanil and dexmedetomidine during craniotomy; A randomised clinical trial

Introduction: Blood loss management in craniotomy is essential for a patient's haemodynamic stability and a significantly better view of the surgical site. The study aimed to address the comparative efficacy of labetalol (LAB), remifentanil (REM) and dexmedetomidine (DXM) on the bleeding control during the craniotomy procedure. Materials and Methods: In a double-blind trial, ninety patients eligible for undergoing craniotomy were recruited and assigned to DXM, LAB and REM groups by the block-randomised method. The vital signs, including heart rate (HR), mean arterial pressure, and oxygen saturation (SaO2) after induction and during the hypotension phase every 15 min until the end of surgery and at recovery and certain time points (2, 4 and 6 h post-operative), were recorded. The amount of bleeding, surgeon satisfaction and dose of propofol used, side effects and haemoglobin level before and 12 h after surgery were registered. Data analysis was conducted using the SPSS software by one-way analysis of variance, repeated measurement test and Chi-square test at a significance level of 0.05. Results: No significant difference was found in vital signs, including SaO2, blood pressure, HR, duration of surgery, extubation time and the amount of propofol consumed, side effects and haemoglobin level (P > 0.05). Nevertheless, the DXM group showed a prolonged recovery time (P = 0.018), less bleeding (P = 0.001) and the highest surgeon satisfaction (P = 0.001) when compared with other groups. Conclusion: Our results showed that DXM helps increase surgeon satisfaction and reduce bleeding while increasing the recovery time. Overall, it does, however, have improved performance without any side effects, based on which DXM can hence be recommended to be used to control bleeding during craniotomy.

Retracted: Anesthesia Effect of Remifentanil Combined with Propofol in Laparoscopic Cholecystectomy and Its Impact on Postoperative Cognitive Recovery.

[This retracts the article DOI: 10.1155/2022/9147416.].

Remifentanil modulates the TLR4‑mediated MMP‑9/TIMP1 balance and NF‑κB/STAT3 signaling in LPS‑induced A549 cells.

Remifentanil is a widely used in general anesthetic that has been found to suppress the inflammatory response in aortic endothelial cells. Therefore, it was hypothesized that remifentanil can inhibit inflammatory dysfunction in lung epithelial cells to alleviate acute lung injury (ALI). The present study aimed to examine the effects of remifentanil on inflammatory injury, MMP-9/tissue inhibitor of metalloproteinase 1 (TIMP1) balance and the potential associated regulatory pathways in A549 cells. Lipopolysaccharide (LPS) was used to treat A549 cells to establish ALI models. The possible roles of different concentrations of remifentanil in cell viability was then determined by CCK-8 and Lactate dehydrogenase release assay. Apoptosis was assessed by flow cytometry analysis and western blotting. Inflammation and oxidative stress were measured by ELISA and corresponding kits respectively. Subsequently, the effects of remifentanil on Toll-like receptor 4 (TLR4) expression and the MMP-9/TIMP1 balance were assessed by western blotting and ELISA. In addition, the effects of remifentanil on NF-κB/STAT3 signaling were evaluated by measuring the protein expression levels of associated pathway components and the degree of NF-κB nuclear translocation using western blotting and immunofluorescence respectively. Remifentanil was found to increase cell viability whilst reducing apoptosis, inflammation and oxidative stress in the LPS-treated cells. In addition, TLR4 inhibitor CLI-095 suppressed MMP-9 expression and secretion while potentiating TIMP1 expression and secretion in LPS-challenged cells. Remifentanil treatment was able to modulate TLR4 to mediate LPS-induced MMP-9/TIMP1 imbalance and suppress the phosphorylation of NF-κB/STAT3 signaling components, in addition to inhibiting NF-κB nuclear translocation. Taken together, remifentanil downregulated TLR4 to reduce MMP-9/TIMP1 imbalance to inhibit inflammatory dysfunction in LPS-treated A549 cells, by regulating NF-κB/STAT3 signaling.

Evaluation and Comparison the Effectiveness of Remifentanil, Nitroglycerin, Esmolol, and Nitroglycerin + Esmolol on Blood Pressure And Heart Rate During Rhinoplasty Surgery

Background: Rhinoplasty is still one of the top five aesthetic surgeries performed and is considered one of the most challenging procedures in otorhinolaryngology surgery. Bleeding is one of the most important factors affecting an operation's success. The controlled hypotension method reduces bleeding; therefore, it provides a satisfying bloodless surgical field during operation. Objective: To evaluate and compare the effectiveness of (Remifentanil, Nitroglycerin, Esmolol, and Nitroglycerin + Esmolol) on hemodynamic parameters and the effectiveness of these drugs in providing a satisfactory bloodless surgical field during rhinoplasty surgery. Patients and Methods: 200 adults aged 20 to 45 years were randomly divided into four groups: Remifentanil (R), Nitroglycerin (N), Esmolol (E), Nitroglycerin + Esmolol (N+E). Systolic blood pressure, diastolic blood pressure, mean blood pressure, and heart rate (SBP, DBP, MBP, and HR) were recorded before anesthesia induction until the operation's end. The bleeding score and the visibility of the surgical field were rated by the surgeon as follows: (0) No bleeding, (1) Mild bleeding - no aspiration required, (2) Mild bleeding - intermittent aspiration is required, (3) Moderate bleeding - frequent aspiration is required, (4) Severe bleeding-constant aspiration is required, (5) Severe bleeding, operation stopped because of surgical field invisibility. Results: As a result, during operation, decreased values of (SBP, DBP, and MBP) were statistically significant in all groups. At the same time, the value of HR showed a statistically significant decrease in the (E) and (R) groups, while there was a statistically significant increase in the (N) and (N+ E) groups. Patients in the (E) and (R) groups had a statistically significantly lower bleeding score than the patients in the (N) and (N + E) groups. Conclusion: Patients had better Hemodynamic stability and surgical field visibility after applying Esmolol and Remifentanil. Keywords: Controlled hypotension, Rhinoplasty, Esmolol, Remifentanil, Nitroglycerin, and Nitroglycerin + Esmolol, Bleeding score, Surgical field visibility.

Evaluation and Comparison the Effectiveness of Remifentanil, Nitroglycerin, Esmolol, and Nitroglycerin + Esmolol on Blood Pressure And Heart Rate During Rhinoplasty Surgery

Background: Rhinoplasty is still one of the top five aesthetic surgeries performed and is considered one of the most challenging procedures in otorhinolaryngology surgery. Bleeding is one of the most important factors affecting an operation's success. The controlled hypotension method reduces bleeding; therefore, it provides a satisfying bloodless surgical field during operation.&#x0D; Objective: To evaluate and compare the effectiveness of (Remifentanil, Nitroglycerin, Esmolol, and Nitroglycerin + Esmolol) on hemodynamic parameters and the effectiveness of these drugs in providing a satisfactory bloodless surgical field during rhinoplasty surgery.&#x0D; Patients and Methods: 200 adults aged 20 to 45 years were randomly divided into four groups: Remifentanil (R), Nitroglycerin (N), Esmolol (E), Nitroglycerin + Esmolol (N+E). Systolic blood pressure, diastolic blood pressure, mean blood pressure, and heart rate (SBP, DBP, MBP, and HR) were recorded before anesthesia induction until the operation's end. The bleeding score and the visibility of the surgical field were rated by the surgeon as follows: (0) No bleeding, (1) Mild bleeding - no aspiration required, (2) Mild bleeding - intermittent aspiration is required, (3) Moderate bleeding - frequent aspiration is required, (4) Severe bleeding-constant aspiration is required, (5) Severe bleeding, operation stopped because of surgical field invisibility.&#x0D; Results: As a result, during operation, decreased values of (SBP, DBP, and MBP) were statistically significant in all groups. At the same time, the value of HR showed a statistically significant decrease in the (E) and (R) groups, while there was a statistically significant increase in the (N) and (N+ E) groups. Patients in the (E) and (R) groups had a statistically significantly lower bleeding score than the patients in the (N) and (N + E) groups.&#x0D; Conclusion: Patients had better Hemodynamic stability and surgical field visibility after applying Esmolol and Remifentanil.

The effect of intravenous remifentanil and fentanyl postoperative delirium incidence in patients receiving elective orthopedic surgeries

Background: The use of certain opioids associated differently with the incidence of postoperative delirium (POD). Remifentanil and fentanyl are short-acting opioids widely used in surgery; however, studies assessing their relationship with POD incidence are still limited. This study aimed to determine the association of remifentanil and fentanyl uses with the incidence of POD in elective orthopedic surgery patients. Methods: A cross-sectional study was conducted in Surgical Unit at Dr Soetomo General Academic Hospital in Surabaya, Indonesia from August to September 2022. Patients who underwent elective orthopedic surgery and used remifentanil (n=16) and fentanyl (n=14) as postoperative analgesia were enrolled in the study. Delirium was assessed using Confusion Assessment Method-ICU tool (CAM-ICU). The associations of remifentanil and fentanyl use as well as patients’ characteristics with POD incidence were assessed statistically. Results: Our data found that there was no significant difference between the incidence of POD with the use of remifentanil (p=0.125) in orthopedic surgery patients. The total doses of fentanyl and morphine equivalent (of remifentanil or fentanyl) were associated significantly with the POD incidence (p=0.010 and p=0.002, respectively). Other factors associated with POD incidence were the use of bone cement during the surgery (p=0.034), duration of surgery (p&lt;0.001), and bleeding volume during the surgery (p=0.024). Conclusions: Our study showed high dose of fentanyl, use of bone cement, longer duration of surgery, and high bleeding volume have greater risk of developing POD in orthopedic surgery patients.

Comparison of the effects of Tranexamic Acid and Remifentanil on the Reduction of Intraoperative and Postoperative Hemorrhage during Dacriocystorhynostomy

Comparison of the effects of Tranexamic Acid and Remifentanil on the Reduction of Intraoperative and Postoperative Hemorrhage during Dacriocystorhynostomy

Long-Term Exposure to Morphine Induces Cross-Tolerance to Acute Antinociceptive Effect of Remifentanil on Somatic and Visceral Stimuli in Rats.

Remifentanil is one of the most commonly used opioids intraoperatively. Previous reports indicate that long-term use of opioids may lead to cross-tolerance to remifentanil, which poses a challenge in the control of acute pain intraoperatively. However, there is limited information regarding cross-tolerance to remifentanil, especially in visceral pain. Therefore, this study aimed to examine cross-tolerance to remifentanil in somatic and visceral tolerance using morphine-tolerant rats. Six male Sprague-Dawley rats were allocated to the morphine and saline groups each. Tolerance to the antinociceptive effect of morphine was induced in rats in the morphine group. Remifentanil was continuously infused intravenously at 10 mcg/kg/min for 120 min to assess cross-tolerance from morphine to remifentanil. The antinociceptive effects on somatic and visceral nociceptive stimuli were measured using the tail-flick (TF) and colorectal distension (CD) tests, respectively. The antinociceptive efficacy was evaluated by converting the response threshold to the percentage maximal possible effect (%MPE). Remifentanil increased the %MPE in the morphine and saline groups in both the tests; however, the increase in %MPE was attenuated significantly in the morphine group compared with that in the saline group at 60, 90, and 120 min (all P < 0.01) in the TF test and at 90 and 120 min in the CD test (all P <0.05). Our results indicate that morphine-tolerant rats exhibit cross-tolerance to remifentanil's acute antinociceptive effects on somatic and visceral stimuli. Cross-tolerance to remifentanil should be considered in the perioperative management of patients using morphine.

Can nociception monitors be used to titrate remifentanil with a stable low noxious stimulation response index (NSRI)?

Purpose: Opioids blunt autonomic nervous system (ANS) responses to noxious stimuli. Nociception monitors analyze the same ANS responses and thus might prove useful to guide opioid dosing. However, concomitantly administered hypnotics also blunt ANS responses and may thus jeopardize the usefulness of nociception monitors to guide intra-operative opioid dosing. We therefore studied the PK (prediction probability) of 3 nociception monitors (NOL index, qNOX and SPI) for the prevailing opioid concentration while maintaining the NSRI (noxious stimulus response index) at a low constant value with a range of opioids and inhaled agent combinations. Methods: In 24 consenting ASA I-II patients undergoing robotic assisted radical prostatectomy, anesthesia was maintained with desflurane in O2/air and remifentanil (target controlled infusion). During the dissection phase, the remifentanil effect site concentration (Ce) in each patient was maintained at 1, 3, or 5 ng/mL for 20 min while the end-expired desflurane concentration (FET) was adjusted to keep the noxious stimulus response index (NSRI) at 5; the sequence in which each patient received each of the three remifentanil Ce was randomized. After stabilization, during each 20 min study period, the following data were collected: NSRI, NOL Index, SPI, qNOX, and FETdes. For each parameter, the prediction probability (PK) for Ce remifentanil was calculated. Results: All patients remained hemodynamically stable. Surgery was finished before the last data collection period in 5 patients with a remifentanil Ce = 5 ng/mL, and in 1 patient with a remifentanil Ce = 1 ng/mL. All other data have been included in the data analysis. The prediction probability (PK) calculated for NOL Index, qNOX and SPI for Ce remifentanil was 0.519, 0.470, and 0.477, respectively. Conclusion: Nociception monitoring becomes useless to titrate opioids when the concomitantly administered hypnotic is adjusted to maintain a low NSRI, presumably because suppression of movement to laryngoscopy also ensures suppression of the sympathetic nervous system response to the noxious stimulus present during intra-abdominal resection of the prostate. Both the hypnotic/opioid ratio and stimulus intensity of the stimulus/response pair need to be considered when attempting to use nociception to guide opioid administration.

Effects of Fentanyl Versus Remifentanil Pretreatment on the QTc Interval in Patients Undergoing Rapid Sequence Intubation: A Randomized Clinical Trial.

One of the complications of laryngoscopy is cardiac dysrhythmia due to an increased QT interval. This study aimed to compare the effect of fentanyl and remifentanil on QTc interval in patients undergoing intubation by the rapid method in 2020. In this study, 50 patients without a history of heart disease and without a history of drug use who were candidates for rapid intubation in the emergency department were selected and divided into two groups. Before the injection of intubation drugs, a baseline ECG was obtained from the patient and then randomly assigned to one group of patients with 2 μg/kg fentanyl and the other group with 1 μg/kg remifentanil. Other intubation drugs, including lidocaine, etomidate, and succinylcholine, were fixed in both groups. Immediately after drug injection and immediately after laryngoscopy, ECG was prepared from patients, and the QT interval was calculated. In group comparison, changes in QT values during the studied time were statistically significant (P = 0.004). However, in the comparison between groups, there was no statistically significant difference between the two groups receiving fentanyl and remifentanil (P = 0.235). The results showed that the rate of QT interval changes during three different measurements increased in both groups of patients receiving fentanyl and remifentanil. In the present study, in comparing the QT interval, there was a statistically significant difference between the two groups receiving fentanyl and remifentanil at any of the studied times. Therefore, fentanyl and remifentanil during endotracheal intubation did not have a statistically and clinically significant effect on the QT distance of patients' ECG, and the administration of the above two drugs during intubation was safe.