• Is remifentanil associated with Opioid Induced Hyperalgesia and Acute Opioid Tolerance?

     
       

    Daniel Jolley.

    12 articles.

    Created July 23, 2019, last updated about 3 years ago.


    Collection: 105, Score: 1455, Trend score: 0, Read count: 1647, Articles count: 12, Created: 2019-07-23 06:05:41 UTC. Updated: 2021-02-07 07:06:53 UTC.

    Notes

    summary
    2
    • Remifentanil infusions above 0.20-0.25 μg/kg/min are associated with hyperalgesia (OIH = Opioid Induced Hyperalgesia) and tolerance (AOT = Acute Opioid Tolerance) respectively.
    • Some of these effects can be mitigated by multimodal analgesia (notably ketamine), and possibly by gradual weaning of a remifentanil infusion.
    • The findings have been predominately identified in rats and volunteer human studies. The clinical and longterm significance is still uncertain.
    • Although OIH and AOT arise from different physiological mechanisms, they are clinically difficult (if not impossible) to differentiate.
    • The clinical priority for management is prevention.
    Daniel Jolley  Daniel Jolley
    pearl
    1

    Intraoperative remifentanil infusions above a certain threshold may be associated with Opioid Induced Hyperalgesia and Acute Opioid Tolerance, although the clinical significance is uncertain,

    Daniel Jolley  Daniel Jolley
     
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