J Gelberg1, C Jonmarker, O Stenqvist, O Werner. 1. Department of Paediatric Anaesthesia and Intensive Care, Children's Hospital, Skane University Hospital, Lund University, 221 85 Lund, Sweden. jan.gelberg@skane.se
Abstract
BACKGROUND: The relative respiratory effects of fentanyl and remifentanil, administered as i.v. bolus, have not previously been studied. We determined what remifentanil bolus dose gave the same maximum depression of ventilation as 1 µg kg(-1) of fentanyl. METHODS: Twelve healthy volunteers rebreathed in a system designed to dampen variations in end-tidal carbon dioxide tension PE'CO2 so that measurements would be obtained at similar levels of CO(2) stimulation. The minute ventilation was measured before (V(preinj)) and after injection (V(nadir)) of fentanyl, 1 µg kg(-1), and remifentanil, 0.25, 0.5, and 1 µg kg(-1). The remifentanil doses were plotted against V(nadir)/V(preinj) in a log-probit diagram to determine what amount gave the same maximum ventilatory depression as the fentanyl dose. RESULTS: V(nadir) was [median (inter-quartile range)] 51 (38-64)% of V(preinj) after fentanyl, and 70 (61-77), 50 (46-56), and 29 (24-38)%, respectively, after remifentanil. The nadir occurred 5.0 (4.4-7.0) min after fentanyl, and 3.8 (2.7-4.6), 2.9 (2.7-3.2), and 3.0 (2.7-3.2) min after remifentanil injection. PE'CO2 at ventilation nadir was 6.26 (5.98-6.62) kPa after fentanyl, and 6.18 (6.12-6.50), 6.11 (5.91-6.45), and 6.11 (5.93-6.45) kPa after remifentanil 0.25, 0.5, and 1 µg kg(-1), respectively. A remifentanil dose of 0.47 (0.42-0.62) µg kg(-1) was equidepressant to 1 µg kg(-1) of fentanyl. Fifteen minutes after fentanyl injection, the median minute ventilation was 30-40% less than after injection of remifentanil, 0.25 and 0.5 µg kg(-1) (P<0.05). CONCLUSIONS: Fentanyl, 1 µg kg(-1), and remifentanil, 0.5 µg kg(-1), gave similar maximum ventilatory depression. The onset of and recovery from ventilatory depression were faster with remifentanil.
BACKGROUND: The relative respiratory effects of fentanyl and remifentanil, administered as i.v. bolus, have not previously been studied. We determined what remifentanil bolus dose gave the same maximum depression of ventilation as 1 µg kg(-1) of fentanyl. METHODS: Twelve healthy volunteers rebreathed in a system designed to dampen variations in end-tidal carbon dioxide tension PE'CO2 so that measurements would be obtained at similar levels of CO(2) stimulation. The minute ventilation was measured before (V(preinj)) and after injection (V(nadir)) of fentanyl, 1 µg kg(-1), and remifentanil, 0.25, 0.5, and 1 µg kg(-1). The remifentanil doses were plotted against V(nadir)/V(preinj) in a log-probit diagram to determine what amount gave the same maximum ventilatory depression as the fentanyl dose. RESULTS: V(nadir) was [median (inter-quartile range)] 51 (38-64)% of V(preinj) after fentanyl, and 70 (61-77), 50 (46-56), and 29 (24-38)%, respectively, after remifentanil. The nadir occurred 5.0 (4.4-7.0) min after fentanyl, and 3.8 (2.7-4.6), 2.9 (2.7-3.2), and 3.0 (2.7-3.2) min after remifentanil injection. PE'CO2 at ventilation nadir was 6.26 (5.98-6.62) kPa after fentanyl, and 6.18 (6.12-6.50), 6.11 (5.91-6.45), and 6.11 (5.93-6.45) kPa after remifentanil 0.25, 0.5, and 1 µg kg(-1), respectively. A remifentanil dose of 0.47 (0.42-0.62) µg kg(-1) was equidepressant to 1 µg kg(-1) of fentanyl. Fifteen minutes after fentanyl injection, the median minute ventilation was 30-40% less than after injection of remifentanil, 0.25 and 0.5 µg kg(-1) (P<0.05). CONCLUSIONS:Fentanyl, 1 µg kg(-1), and remifentanil, 0.5 µg kg(-1), gave similar maximum ventilatory depression. The onset of and recovery from ventilatory depression were faster with remifentanil.
Authors: Sebastian Zaremba; Christina H Shin; Matthew M Hutter; Sanjana A Malviya; Stephanie D Grabitz; Teresa MacDonald; Daniel Diaz-Gil; Satya Krishna Ramachandran; Dean Hess; Atul Malhotra; Matthias Eikermann Journal: Anesthesiology Date: 2016-07 Impact factor: 7.892