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Remifentanil for general anaesthesia: a systematic review

  1. R. Komatsu1,2,
  2. A. M. Turan3,
  3. M. Orhan-Sungur4,
  4. J. McGuire5,
  5. O. C. Radke6,
  6. C. C. Apfel2,7

Article first published online: 5 NOV 2007

DOI: 10.1111/j.1365-2044.2007.05221.x

Issue

Anaesthesia

Anaesthesia

Volume 62, Issue 12, pages 1266–1280, December 2007

Additional Information

How to Cite

Komatsu, R., Turan, A. M., Orhan-Sungur, M., McGuire, J., Radke, O. C. and Apfel, C. C. (2007), Remifentanil for general anaesthesia: a systematic review. Anaesthesia, 62: 1266–1280. doi: 10.1111/j.1365-2044.2007.05221.x

Author Information

  1. 1

     Clinical Instructor, Department of Anaesthesiology, Tokyo Women's Medical University, 8–1 Kawada-cho, Shinjukuku, Tokyo 162–8666, Japan

  2. 2

     Outcomes Research Institute, University of Louisville, 501 E Broadway, Suite 210, Louisville, KY 40202, USA

  3. 3

     Assistant Professor, Department of Anaesthesiology & Perioperative Medicine, and the Outcomes Research Institute, University of Louisville, USA

  4. 4

     Assistant Professor, Department of Anaesthesia, Capa Medical School, Istanbul University, Istanbul, Turkey

  5. 5

     Research Associate, Department of Anaesthesia and Perioperative Care, UCSF Medical Center at Mount Zion, San Francisco, USA

  6. 6

     Visiting Assistant Professor, Department of Anaesthesia and Perioperative Care, San Francisco General Hospital, USA

  7. 7

     Associate Professor, Department of Anaesthesia and Perioperative Care, Mt. Zion UCSF Medical Center, San Francisco, USA

*C. C. Apfel E-mail: apfel@ponv.org

Publication History

  1. Issue published online: 5 NOV 2007
  2. Article first published online: 5 NOV 2007
  3. Accepted: 20 April 2007

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Summary

We performed a quantitative systematic review of randomised, controlled trials that compared remifentanil to short-acting opioids (fentanyl, alfentanil, or sufentanil) for general anaesthesia. Eighty-five trials were identified and these included a total of 13 057 patients. Intra-operatively, remifentanil was associated with clinical signs of deeper analgesia and anaesthesia, such as fewer responses to noxious stimuli (relative risk 0.65, 95% CI 0.48–0.87), more frequent episodes of bradycardia (1.46, 1.04–2.05), more hypotension (1.68, 1.36–2.07) and less hypertension (0.60, 0.46–0.78). Postoperatively, remifentanil was associated with faster recovery (difference in extubation time of −2.03, 9.5% CI, −2.92 to −1.14 min), more frequent postoperative analgesic requirements (1.36, 1.21–1.53) and fewer respiratory events requiring naloxone (0.25, 0.14–0.47). Remifentanil had no overall impact on postoperative nausea (1.03, 0.97–1.09) or vomiting (1.06, 0.96–1.17), but was associated with twice as much shivering (2.15, 1.73–2.69). Remifentanil does not seem to offer any advantage for lengthy, major interventions, but may be useful for selected patients, e.g. when postoperative respiratory depression is a concern.

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