Effect of remifentanil on the recovery profile after head and neck surgeries: A prospective study

Thangavelautham Suhitharan; Sudhakar Subramani; Ma Thin Mar Win; Widyawaty Binte Sulaiman; Nurain Binte Johar; Ong Biauw Chi

doi:10.4103/joacp.JOACP_337_16

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Effect of remifentanil on the recovery profile after head and neck surgeries: A prospective study

Thangavelautham Suhitharan, Sudhakar Subramani, Ma Thin Mar Win, Widyawaty Binte Sulaiman, Nurain Binte Johar and Ong Biauw Chi

Journal of anaesthesiology, clinical pharmacology, Vol.34(3), pp.307-313

07/2018

DOI: 10.4103/joacp.JOACP_337_16

PMCID: PMC6194847

PMID: 30386011

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Abstract

Development of opioid tolerance in the perioperative period due to remifentanil remains controversial. We evaluated occurrence of opioid tolerance and other adverse effects due to remifentanil in patients undergoing head and neck surgery. We recruited adult participants with ASA status I to III who received general anesthesia for approximately 2 h for elective head and neck procedures. Remifentanil infusion was used in one group and intermittent boluses of morphine or fentanyl were administered in another group. Postoperative pain was treated with intermittent boluses of morphine and fentanyl in post-anaesthesia care unit (PACU) to achieve a numerical rating scale score of 3. Opioid requirement was assessed as an indicator of opioid tolerance. Patients were also evaluated for time to discharge from PACU. We studied 222 adults aged between 21 and 80 years. One hundred and eleven patients received a combination of remifentanil infusion and morphine boluses, and another 111 patients received only fentanyl and/or morphine boluses intraoperatively. Fifty-one patients in the remifentanil group and 25 in the fentanyl/morphine group required opioids in the PACU. Opioid requirement were significantly more (mean ± SD, 44.98 ± 59.7 Vs 20.23 ± 46.66 mcg.kg ; = 0.001) and required longer time to discharge from PACU in the remifentanil group compared to the fentanyl/morphine group (Mean ± SD, 88.6 ± 39.5 min Vs 73.1 ± 38.4 min; < 0.001). No difference in the incidence of adverse effects in two groups was noted. At clinically relevant doses, intraoperative remifentanil infusion appears to increase opioid consumption in the immediate postoperative period. This can result in delayed discharge from PACU for patients undergoing elective head and neck procedures.

opioid tolerance

Head and neck surgery

remifentanil

Details

Title: Subtitle: Effect of remifentanil on the recovery profile after head and neck surgeries: A prospective study
Creators: Thangavelautham Suhitharan - Department of Anesthesiology, Singapore General Hospital, Singapore
Sudhakar Subramani - Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa, USA
Ma Thin Mar Win - Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Widyawaty Binte Sulaiman - Department of Anesthesiology, Singapore General Hospital, Singapore
Nurain Binte Johar - Department of Anesthesiology, Singapore General Hospital, Singapore
Ong Biauw Chi - Department of Anesthesiology, Singapore General Hospital, Singapore
Resource Type: Journal article
Publication Details: Journal of anaesthesiology, clinical pharmacology, Vol.34(3), pp.307-313
DOI: 10.4103/joacp.JOACP_337_16
PMID: 30386011
PMCID: PMC6194847
NLM abbreviation: J Anaesthesiol Clin Pharmacol
ISSN: 0970-9185
eISSN: 2231-2730
Publisher: India
Language: English
Date published: 07/2018
Academic Unit: Anesthesia
Record Identifier: 9984006478002771

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