remifentanil

Remifentanil seems to play an important role in reducing heart rate (HR) and blood pressure during electroconvulsive therapy (ECT)-induced seizures. The majority of studies have focused on the role of the intravenous administration of this drug in combination with other anesthetics; however, the effect of intranasal administration of this drug has received less attention so far. We evaluated the effect of the intranasal administration of remifentanil at different doses on ECT-induced hemodynamic changes.

This double-masked clinical trial was conducted on 80 ECT candidates divided into four groups. Before starting the ECT, the four study groups, namely REM-25, REM-50, REM-75, and control, intranasally received remifentanil at 25, 50, and 75 μg and placebo, respectively. Anesthesia induction drugs were injected 1 minute after the intranasal administration of remifentanil or placebo. Patient’s HR, diastolic blood pressure (DBP), mean arterial pressure (MAP), systolic blood pressure (SBP), and peripheral capillary oxygen saturation (SpO2) were evaluated and recorded before and 1, 5, 10, and 20 minutes after the end of convulsive movements.

The patients’ SBP and MAP with 137.30±14.37 mm Hg and 100.50±11.06 mm Hg, respectively, had the highest mean in the control group as compared to three remifentanil groups 5 minutes after ECT (P value=0.042). In addition, the increase in patients’ HR in the REM-75 group, with an average of 7.70±12.54 bpm, was significantly lower than that of the REM-25 and REM-50 groups, with means of 16.15±13.80 bpm and 13.15±8.03 bpm, respectively. Moreover, the controls, with an average of 23.00±11.74 bpm, had the greatest increase in HR (P value<0.05).

The intranasal administration of remifentanil at different doses did not affect the length of ECT-induced seizures; however, its maximum dose (75 μg) showed the greatest decrease in patients’ SBP, MAP, and HR five minutes after administration.

To evaluate the impact of a very low dose of naloxone added to a remifentanil infusion on postoperative pain in patients undergoing hip replacement surgery in the lateral position.

This randomized clinical trial included 80 patients candidates undergoing hip replacement surgery under general anesthesia were randomly divided into two groups of 40 using block randomization: group 1 received remifentanil at a dose of 0.3 μg/kg/min, while group 2 received remifentanil at a dose of 0.3 μg/kg/min with a very low dose of naloxone administered at 0.05 μg/kg/h following injection. Postoperative pain (measured using VAS pain assessment criteria), drowsiness caused by narcotics and analgesics in recovery, and the duration of getting out of bed were all monitored and recorded in the ward.

The mean time to administration of the first sedative drug was 1.30 ± 1.89 hours in the control group and 3.20 ± 2.55 hours in the intervention group. The difference between the groups in this regard was statistically significant (P <0.0001). The frequency of pain after surgery at 0, 4 and 8 hours was significantly different between the control and intervention groups (P = 0.003, P <0.0001, and P=0.021, respectively).

Based on the results, we recommend using a very low dose of naloxone along with remifentanil infusion in patients undergoing complete hip replacement surgery to reduce their pain and the need for painkillers.

Background &  The presence of anesthetic drugs in the serum with possible negative effects on FSH and LH hormone concentration and vital signs has been shown in a number of experimental and human research.To measure the effects on blood hormone concentration and the effect on the vital signs (blood pressure and heart rate) of two different medications (remifentanil vs. fentanyl) used for general anesthesia during oocyte retrieval.Materials &  The present prospective comparative study was carried out at Iraq's "High Institute of Infertility Diagnosis and Assisted Reproductive Technologies/Reproductive Physiology/Al-Nahrain University/Baghdad/Iraq" infertility center with the approval of the Faculty of Science's ethical committee. Mansoura University approved the study's validity. Ninety infertile women who are undergoing intracytoplasmic sperm injections (ICSI) for a variety of infertility-related reasons. The women ranged in age from 25 to 45. The study's original December 2022 deadline was pushed out to December 2023. Patients were split into two groups based on the general anesthesia technique for oocyte retrieval. Group one (45 patients) received midazolam, propofol, and fentanyl; group two (45 patients) received remifentanil, midazolam, and propofol. We compared the FSH and LH hormone levels before and after anesthesia and also compared the effect of anesthesia on vital signs between two groups of patients before and after anesthesia; accordingly, there was significantly higher systolic blood pressure in remifentanil group (p=0.30); however, there were no significant differences in diastolic blood pressure (p=0.767) and heart rates (p=0.512). The associations of LH and FSH with anesthesia are different depending on the type of anesthetic drugs.

The presence of anesthetic drugs in the serum with potential negative effects on hormone concentration and pregnancy rate has been shown in a number of human research. To assess the effects on blood hormone concentration and pregnancy rate of two different medications (remifentanil vs. fentanyl) used for general anesthesia during oocyte retrieval.

the present prospective comparative study was conducted at Iraq's "High Institute of Infertility Diagnosis and Assisted Reproductive Technologies/Al-Nahrain University/Baghdad/Iraq" infertility center and was approved by Mansoura University for its validity. Sixty infertile women who were having (ICSI) for a range of infertility-related reasons that entered the study. The women's ages varied from 20 to 45 years. The study's length was extended from September 2022 to September 2023. According to the general anesthetic protocol for oocyte retrieval, those patients were divided into two groups. Midazolam, propofol, and fentanyl were given to the group one, while remifentanil, midazolam, and propofol were given to the group two.

Compare the hormone levels before and after fentanyl anesthesia. The current study's findings indicated that remifentanil led to a greater pregnancy rate (40.0%) than fentanyl (36.7%). According to the results, there were significantly higher LH levels after fentanyl anesthesia (P = 0.014). However, insignificantly higher FSH (P = 0.481) and prolactin (P = 0.076) levels post-fentanyl anesthesia. Also, significantly higher LH levels after remifentanil anesthesia (P = 0.046), insignificantly higher FSH levels (P = 0.383) and prolactin levels (P = 0.16) after remifentanil anesthesia. In the fentanyl group, the recovery time was substantially longer (P<0.001).

Because of its quicker recovery time and much greater pregnancy rate, remifentanil is preferred over fentanyl in normal general anesthetic treatments for egg harvest in ICSI operations.

 Total knee arthroplasty (TKA) is a standard surgical procedure for individuals with debilitating knee arthritis. Effective postoperative pain management is essential for successful recovery, although traditional opioid-based methods have limitations.

 This study aimed to compare the efficacy of Apotel and Remifentanil patient-controlled analgesia in managing postoperative pain after TKA.

 This double-blind, randomized, controlled clinical trial took place at Amir-al-Momenin and Qods Hospitals in Arak, Iran, spanning from June 2022 to September 2023. Sixty-two eligible patients scheduled for knee joint replacement were randomly assigned to receive either Apotel (Group A) or Remifentanil (Group R) as part of multimodal analgesia administered via a pain pump for postoperative pain relief in TKA. The study assessed hemodynamic parameters, pain levels (measured using the Visual Analog Scale), analgesic duration, and narcotic consumption. Statistical analyses were performed using SPSS v.27 and Plotly.

 Subjects exhibited no statistically significant differences in age, gender distribution, duration of surgery, or anesthesia. The hemodynamic status assessment in the recovery room showed no significant differences in SPO2, PR, or MAP between the groups. However, Remifentanil demonstrated superior effectiveness in reducing pain over 24 hours post TKA surgery compared to Apotel, as evidenced by lower average Visual Analog Scale (VAS) scores (P < 0.001), longer duration without the need for narcotic painkillers (P < 0.001), and lower cumulative opioid analgesic consumption in Group R (P < 0.001).

 Remifentanil demonstrates superior pain control in a multimodal pain management approach compared to Apotel, providing sustained pain reduction over 24 hours post-surgery. Moreover, Remifentanil offers longer-lasting pain relief and results in lower cumulative narcotic painkiller consumption compared to Apotel.

Burns are among the most life-threatening forms of trauma requiring timely and effective treatment.

The present study aimed to assess the inhibitory effect of remifentanil on the stress response of burn patients undergoing escharectomy and skin grafting.

A total of 52 patients undergoing burn scab removal surgery were selected and randomly assigned to two groups: remifentanil group (group R) and fentanyl (group F). Anesthesia induction: Group R was administered an intravenous injection of propofol, rocuronium, and remifentanil, while Group F received an intravenous injection of propofol, rocuronium, and fentanyl. After tracheal intubation, group R was injected intravenously with remifentanil and propofol to maintain anesthesia. Group F was induced with fentanyl. Thereafter, the patient's blood pressure and heart rate (HR) were recorded. Subsequently, their carotid artery blood was withdrawn, and they were tested for epinephrine (E), norepinephrine (NE), and blood glucose. Finally, the patients' eye-opening time and extubation time at the end of anesthesia were recorded.

After anesthesia induction, the mean artery pressure, HR, and E in group R were lower than those in group F. There was no statistically significant difference between the levels of NE in the two groups. Nonetheless, the eye-opening time and extubation time in group R were significantly shorter than those in group F.

Compared to fentanyl, remifentanil can more effectively reduce the stress response of surgery and anesthesia. It can integrate anesthetic drugs with blood pressure control. Furthermore, this method is simple, effective, safe, and reliable.

Due to the increase in elective cesarean section and its high complications, epidural analgesia is the gold standard for reducing the pain of vaginal delivery. In contraindication cases, other effective and safe analgesic methods such as remifentanil are suggested. The present study aimed to compare the duration of active phase of labor at stages I and II, as well as neonatal Apgar score following the use of remifentanil analgesia.

In this study, 120 healthy primiparous women who were candidates for vaginal delivery were selected. After matching for age and body mass index (BMI), the participants were assigned into two equal groups (n=60 each) of intervention (receiving remifentanil) and control. We compared the duration of active phase of labor at stages I and II, neonatal Apgar scores, and the cesarean section rate between the groups. Statistical analysis was performed using SPSS software (version 23).

There was no statistically significant difference between the two groups in terms of the duration of active phase in the first and second stages of labor (P=0.84 and P=0.78, respectively), 1-minute Apgar score (P=0.95), 5-min Apgar score (P=0.92), and the rate of cesarean section (P=0.067). Moreover, we observed no maternal complications with remifentanil.

According to our results, remifentanil did not increase the duration of labor, rate of cesarean section, and maternal complications. Hence, it can be a good alternative in cases where epidural analgesia is contraindicated.

This study aimed to assess and compare the effects of intranasal administration of lidocaine andremifentanil on the condition of LMA insertion and cardiovascular response. From March 2019 to March 2020, this double-blind randomized clinical trial study was conductedon 60 patients, who underwent general anesthesia with LMA insertion at Faiz Hospital, Isfahan, Iran. Afterinduction of anesthesia and before placing the laryngeal mask, the first group received remifentanil 1 μg/Kg,the second group received lidocaine 2% 1 mg/Kg, and the third group received normal saline with the samevolume intranasally. The conditions of LMA insertion and hemodynamic changes that occurred during itsinsertion were investigated. In terms of demographics characteristics (p>0.05), success in placing the LMA on the first try(p=0.73), number of attempts to insert LMA (p=0.61), performance of LMA (p=0.73), need for additionalpropofol (p=0.53), frequency of gagging (p=0.53), cough (p=0.15) p), and laryngospasm (p=0.99) did notdiffer significantly. In the remifentanil group, the cardiovascular response to LMA injection was less than thatof the lidocaine group. Moreover, both groups were lower than the saline group, but no significant differencewas observed In facilitating LMA insertion, the effect of intranasal remifentanil was comparable to intranasallidocaine. Intranasal remifentanil was somewhat more effective than intranasal lidocaine in weakening thecardiovascular response to LMA insertion, but it did not outperform lidocaine.

Depression is a prevalent mental disorder affecting more than 300 million people of all ages globally. Despite being the first-line treatment for depression, antidepressant medications are only effective for 60% - 70% of patients. Electroconvulsive therapy (ECT) is an effective treatment for severe cases, although it can result in short-term side effects.

This study aimed to compare the effectiveness of remifentanil, dexmedetomidine, and metoral as premedications for ECT in patients with major depressive disorder (MDD).

In this prospective double-blinded randomized controlled clinical trial, a total of 120 MDD patients aged 18 - 60 were included. They were randomly assigned to receive remifentanil, dexmedetomidine, or metoral in combination with thiopental before ECT. Hemodynamic responses (mean arterial blood pressure, pulse rate, arterial blood oxygen saturation), seizure duration, recovery time, agitation scores, and patient satisfaction scores (reverse coded) were measured and compared.

Dexmedetomidineexhibited superiorhemodynamiccontrol with lowermeanarterial blood pressure (P< 0.001)andpulse rate (P < 0.001) than remifentanil and metoral. Patients receiving dexmedetomidine or remifentanil showed reduced agitation (P < 0.001) and better satisfaction than the metoral group (P < 0.001). Remifentanil displayed intermediate outcomes, while metoral exhibited the least favorable results. Seizure duration was not significantly different between the dexmedetomidine and remifentanil groups (P = 0.843).

Dexmedetomidine is considered the most satisfactory group due to the better control of blood pressure, heart rate, and agitation and better patient satisfaction despite the longer recovery time.

 Finding the optimal combination of anesthetics to maintain hemodynamic stability during surgery can be challenging. Traditionally, strong opioid analgesics such as fentanyl and its newer analogs have been used. However, the use of narcotics is associated with certain side effects.

 This study compares the effects of labetalol and remifentanil in pain control after bariatric surgery in Hazrat Rasool Akram Hospital.

 This randomized, double-blind clinical trial was conducted on 48 laparoscopic bariatric surgery patients. The participants were randomly divided into two groups receiving remifentanil or labetalol. Postoperative pain was measured in the recovery unit using the numerical rating scale (NRS). This score was recorded upon entering recovery, and 30 minutes, 60 minutes, and 120 minutes after surgery for each patient. Also, the duration of anesthesia, the duration of the operation, the recovery time, the dose of the administered opioids, the volume of intravenous fluids, and the dose of administered propofol were recorded for each patient. Nausea and vomiting after the operation were also recorded as outcomes.

 There were no significant differences between the two groups regarding the mean duration of surgery and anesthesia, dose of the administered anesthetics, recovery period, nausea and vomiting, and the dose of analgesics after the operation. The mean pain intensity during the given period and also the trend of pain intensity changes between the two groups demonstrated no statistically significant differences (P = 0.112). During the operation, 9 subjects (37.5%) in the labetalol group and 16 (66.7%) in the remifentanil group needed more analgesics (rescue drug); in this regard, a significant difference was observed between the two groups (P = 0.043).

 Based on the study’s findings, there were no significant differences between labetalol and remifentanil in post and perioperative pain control. However, rescue drugs needed to maintain hemodynamic stability during laparoscopic surgery were significantly lower in patients who received labetalol than remifentanil. Postoperative complications were also comparable between labetalol and remifentanil.

Rhinoplasty is a complex but popular surgery in Iran. The main complications of the surgery are post-operative bleeding and nasal septal hematoma due to poor intra-operative controlled hypertension. This study aimed to compare the efficacy of isoflurane-remifentanil (I-R) versus propofol-remifentanil (P-R) to induce controlled hypotension and to assess surgeon satisfaction with each of these combinations during rhinoplasty.  In 2020-2021, a single-blind clinical study was conducted on 98 patients aged 18-50 years undergoing rhinoplasty at Mother and Child Hospital (Shiraz, Iran). Patients were randomly divided into P-R (n=48) and I-R (n=50) groups. Changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were assessed during surgery and in the recovery room. A questionnaire was used to evaluate the level of surgeon satisfaction. Data were analyzed using independent samples t test, Chi-square test, and repeated measures ANOVA with SPSS software. P<0.05 was considered statistically significant. Five minutes after anesthesia induction, the P-R combination had a greater effect on reducing SBP (P=0.010), DBP (P=0.007), MAP (P=0.003), and HR (P=0.026) than I-R. However, from the 40th minute to the end of surgery and after 30 minutes of recovery, the I-R combination had a slightly better effect on blood pressure reduction than P-R. There was no difference in surgeon satisfaction with either of the two drug combinations. Both P-R and I-R combinations are recommended to induce hypotension during rhinoplasty. However, I-R is more effective than P-R in inducing the desired controlled hypotension.

Intratracheal intubation is associated with many side effects. Different groups of drugs have been used to control these side effects, but there is still no consensus on the most suitable drugs.
This study aimed to compare the effect and possible side effects of fentanyl, remifentanil, and atropine plus remifentanil on the vital signs of preterm infants in non-emergency intratracheal intubation.
In this randomized clinical trial study, 75 neonates with a gestational age of 27 to 34 weeks who required temporary intubation were included in the study and divided into three groups by computer randomization. Then, the effects and possible side effects of remifentanil, fentanyl, and remifentanil with atropine on clinical parameters (blood pressure, heart rate, and arterial oxygen saturation) were investigated.
A total of 75 neonates with a mean gestational age of 30.4 weeks were studied. There was no significant difference between study groups in terms of changes in the systemic blood pressure and heart rate, but the mean oxygen saturation in all three groups was significantly different at different measurement times (P-value: 0.036). The group receiving remifentanil plus atropine reported minimal changes in oxygen saturation and their oxygen saturation was significantly higher than the other groups 30 min after extubation.
The use of remifentanil with atropine in preterm infants is associated with lower changes in oxygen saturation and higher arterial oxygen saturation 30 min after extubation. The use of remifentanil or remifentanil with atropine or fentanyl has no significant effect on the blood pressure and heart rate of neonates in non-emergency intratracheal intubation.

Depression is highly prevalent during pregnancy and after childbirth, and many factors, including the type of delivery, can contribute to developing this condition. Considering the increased use of remifentanil in painless labor and the need for conducting more studies on the consequences of this method this study aimed to determine the mean score of postpartum depression in women giving birth by either remifentanil-induced painless delivery or elective cesarean section.

The present study was a longitudinal investigation conducted on140 women referred to private hospitals, Tabriz, Iran, between 2020 and 2021 in two groups: women with elective cesarean delivery and women with vaginal delivery with remifentanil analgesia (n=70/each). Depression during pregnancy was assessed at 35-37th weeks’ gestation, and postpartum depression was determined four weeks after childbirth using the Edinburgh Postnatal Depression Scale (EPDS). Independent t test and paired t test were used to compare depression scores.

Postpartum depression was significantly higher in women who had undergone a cesarean section than in those giving birth by remifentanil-induced painless vaginal delivery (P = 0.009).

The prevalence of postpartum depression was higher in women who underwent elective cesarean section than women who underwent painless vaginal delivery with remifentanil. Considering the steady rise in worldwide cesarean section rate and the health burden and consequences of postpartum depression on mothers and children, health legislators should take measures to reduce women’s tendency towards the cesarean section in the long run

Oximetry is a method for measuring the arterial hemoglobin saturation (SpO2) using pulse oximeter and is essential in any type of anesthetic procedures. The growing population of geriatrics in the recent decades in combination with an increase in the prevalence of chronic diseases including diabetes and hypertension are some of the leading causes for an increase in the prevalence of chronic kidney disease and end-stage renal disease (ESRD). The definite treatment for ESRD is renal transplant but unfortunately, it may take a long time to find a suitable kidney and continuing the patient’s life may depend on dialysis. Arteriovenous fistula (AVF) formation is one of the first steps to prepare the patient for hemodialysis. ESRD itself is a reason for physical and psychosocial issues. Preparing a favorable condition for AVF surgery is essential to decrease the burden of the underlying disease. An efficient respiratory supply is necessary in all parts of an anesthetic procedures. Aims and

This study is a double-blind clinical trial to compare two anesthetic agents, dexmedetomidine and remifentanil in patients with ESRD who underwent AVF formation.

SpO2 was measured on different phases including the time of initial incision, and after 10, 30, 60, 90, and 120 min of finishing the surgery. The data were analyzed using SPSS version 22, two-way repeated measures (ANOVA), and independent t-test.

This study showed that there was no any significant difference in using any of these two agents with regard to SpO2 in the different times of measurements during the anesthetic procedure and after the surgery in the recovery phase.

This study showed that there is not any superiority in using DEX or REM in the patients undergo AVF formation. More studies on the other groups of the patients with different surgeries.

 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.

The target-controlled infusion (TCI) system controls the plasma concentration of administered drugs, improves hemodynamic stability, prevents the cumulative effect of drugs, provides faster recovery, and perhaps reduces renal complications. We sought to investigate the effects of the TCI method on blood urea nitrogen (BUN) and creatinine (Cr) levels in patients with renal impairment undergoing open-heart surgeries.

This double-blind clinical trial was performed on 66 patients undergoing cardiac surgeries with preoperative Cr levels of greater than 1.5 mg/dL. The patients were randomly divided into 3 groups. The first group received propofol and remifentanil via the TCI system. The second group received these 3 drugs via the usual dosing (mg/kg) method. The third group received midazolam and fentanyl conventionally (based on the mg/kg method). Postoperative Cr and BUN levels, urine volume, the need for dialysis, and hemodynamic parameters were recorded up to 3 postoperative days. After the exclusion of 10 patients from the study, 56 patients were analyzed.

Postoperative BUN and Cr values were significantly lower in the TCI group than in the other groups (P<0.05) There were no significant differences between the 3 groups concerning hemodynamic status. The total dose of anesthetics was significantly lower in the TCI group than in the propofol-remifentanil group (P<0.05). The incidence of postoperative arrhythmias in the TCI group was significantly lower than that in the other 2 groups (P<0.05).

In our patients with renal dysfunction, the TCI method reduced post-cardiac surgery BUN and Cr levels, the dose of the anesthetics administered, and the incidence of arrhythmias.