Masui. The Japanese journal of anesthesiology
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Review Case Reports
[Clinical electroencephalographic monitoring of depth of anesthesia].
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Remifentanil is a potent mu-opioid receptor agonist and has some unique pharmacokinetic characteristics compared with fentanyl. Properties of remifentanil such as rapid onset of action, easy titration of concentration and quick emergence even after a long duration of anesthesia with high doses may produce analgesia strong enough to keep patients free from surgical stresses during general anesthesia. Understanding its pharmacological advantages and some experiences will provide better care for our patients. Analgesia-oriented opioid-based anesthesia with remifentanil will become a new trend that may significantly alter our anesthesia practice.
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Individual variation in the sensitivity to anesthetics induces the delayed awakening and the severe postoperative pain at an inappropriate dose. We designed the study to see the correlation of the individual sensitivity to fentanyl and that to propofol which have different mechanism. ⋯ The correlation of the individual sensitivity to fentanyl and propofol was found in older age groups.
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Providing analgesia is the most important, yet the most difficult aspect of remifentanil anaesthesia, as its effect wears off quickly after infusion is terminated. Longer-acting opioids such as morphine and fentanyl must be given well before patients wake up. Bolus administration of fentanyl approximately 20 minutes before the end of surgery may provide adequate analgesia at emergence and tracheal extubation. ⋯ However, in some susceptible patients, even a very low-rate infusion can still cause significant respiratory depression more than 30 minutes after starting infusion. Pulse oximetry is not sensitive enough to detect early ventilatory depression when patients breathe oxygen-enriched air. Without continuous observation by trained anaesthetists, infusion of remifentanil should not be used casually particularly in non-ventilated patients.