Remifentanil for analgesia-based sedation in the intensive care unit 英文参考文献.docVIP

Available online /content/8/1/13 Commentary Remifentanil for analgesia-based sedation in the intensive care unit Ralf Kuhlen1 and Christian Putensen2 1Professor of Anesthesia and Intensive Care Medicine, Department of Anesthesia, University Hospital Aachen, Germany 2Professor of Anesthesia and Intensive Care Medicine, Department of Anesthesia and Intensive Care Medicine, University of Bonn, Germany Correspondence: Ralf Kuhlen, rkuhlen@ukaachen.de Published online: 17 December 2003 Critical Care 2004, 8:13-14 (DOI 10.1186/cc2421) This article is online at /content/8/1/13 ? 2004 BioMed Central Ltd (Print ISSN 1364-8535; Online ISSN 1466-609X) Abstract Providing effective analgesia and adequate sedation is a generally accepted goal of intensive care medicine. Due to its rapid, organ independent and predictable metabolism the short acting opioid remifentanil might be particularly useful for analgesia-based sedation in the intensive care unit (ICU). This hypothesis was tested by two studies in this issue of Critical Care. The study by Breen et al. shows that remifentanil does not exert prolonged clinical effects when continuously infused in renal failure patients, although the weak acting metabolite remifentanil acid accumulates. The study by Muellejans et al. reports a multicenter trial comparing a remifentanil versus a fentanyl based regimen in ICU patients. With both substances a target analgesia and sedation level was reached, and no major differences were found when frequent assessments of the sedation level and according readjustments of doses were performed. These results are in accordance with other studies suggesting that the adherence to a clear analgesia-based sedation protocol might be more important then the choice of medications itself. Keywords analgesia, sedation, remifentanil, organ failure Providing effective analgesia and adequate sedation is a supplemented by propofol in ICU patients with im