Article Notes
Some of the assertions in this review are challengable, and based upon sources with lesser certainty than suggested. For example:
"COVID-19 is predominantly caused by contact or droplet transmission..." - Cook
Yet the reference for this is a Public Health England statement describing this as an 'assumption' without evidence. In contrast there is now considerable debate as to the significance of airborne COVID-19 transmission.
"The transmission of COVID-19 is thought to occur mainly through respiratory droplets generated by coughing and sneezing, and through contact with contaminated surfaces. The predominant modes of transmission are assumed to be droplet and contact." – Public Health England
Because PPE recommendations are based upon this assumption, caution is still required.
The title of this paper is pretty vague and possibly even misleading: “unexpectedly unfavorable outcomes”...? Generally ‘outcome’ is used in service to something broader and longer-term, such as procedural success, long-term comfort, time to discharge, or functional recovery.
A more appropriate and descriptive title would have been: “Remifentanil for abdominal surgery is associated with worse analgesia and more PONV in the PACU.” 👍
Although we know that OIH and AOT are issues for remifentanil and may explain the PACU analgesia differences observed in this study, it’s also possible that worse PACU pain scores occur because anesthetists/anesthesiologists have not adequately transitioned from short-acting to longer-acting analgesics at the end of the case.
That is, the findings may represent inadequate pre-emergence analgesia because of the complexity of managing pharmacokinetic transitions, rather than a direct pharmacodynamic effect of remifentanil...
My money is still on this being acute hyperalgesia and tolerance, but keep an open mind...
See also the reply letter from Audra Webber and Melissa Kreso: Informed Consent for Sugammadex and Oral Contraceptives: Through the Looking Glass.