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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Stratification and doses of opioids for head and neck procedures

Stratification and doses of opioids for head and neck procedures
Stratification of opioid infusions for head and neck surgery
Degree of postoperative pain Opioid regimen
None to mild Remifentanil infusion +/– fentanyl 1 mcg/kg total dose
Mild to moderate

Remifentanil infusion + fentanyl 1 to 3 mcg/kg total dose

OR

Alfentanil infusion
Moderate to severe

Sufentanil infusion +/– remifentanil infusion*

OR

Fentanyl infusion +/– remifentanil infusion*
Opioid doses for head and neck surgery[1-23]
Opioid IV load IV infusion
Fentanyl 3 to 7 mcg/kgΔ 0.7 to 2.5 mcg/kg/hour◊
Sufentanil 0.25 to 1.5 mcg/kgΔ
TCI: 0.4 to 0.5 ng/mL		 0.2 to 0.3 mcg/kg/hour
TCI: 0.2 to 0.65 ng/mL
Alfentanil 20 to 40 mcg/kg
TCI: 100 to 200 ng/mL		 0.25 to 1.5 mcg/kg/minute
TCI: 60 to 150 ng/mL
Remifentanil 0.5 to 2 mcg/kg
TCI: 4 ng/mL		 0.05 to 0.3 mcg/kg/minute
TCI: 1.5 to 9 ng/mL
TCI with opioids and propofol allows for easier and more rapid titration of drugs to patient responses and facilitates intraoperative hemodynamic control, as well as rapid recovery from anesthesia.
IV: intravenous; TCI: target-controlled infusion; TIVA: total IV anesthesia; N2O: nitrous oxide.
* May be additionally required during highly stimulating parts of the surgical procedure.
¶ Assumes: IV induction with propofol 1 to 2 mg/kg, maintenance of TIVA with propofol 80 to 180 mcg/kg/minute (TCI 3 to 5 mcg/mL), and no N2O administration.
Δ We titrate the loading dose of fentanyl or sufentanil using the clinical endpoints during induction, such as either a decrease of respiratory rate or onset of sedation.
◊ Fentanyl infusion should be used with caution and adjusted accordingly due to its long, context-sensitive half-life.
References:
  1. Erhan E, Ugur G, Gunusen I, et al. Propofol - not thiopental or etomidate - with remifentanil provides adequate intubating conditions in the absence of neuromuscular blockade. Can J Anaesth 2003; 50:108.
  2. Jellish WS, Leonetti JP, Avramov A, et al. Remifentanil-based anesthesia versus a propofol technique for otologic surgical procedures. Otolaryngol Head Neck Surg 2000; 122:222.
  3. Eberhart LH, Eberspaecher M, Wulf H, et al. Fast-track eligibility, costs and quality of recovery after intravenous anaesthesia with propofol-remifentanil versus balanced anaesthesia with isoflurane-alfentanil. Eur J Anaesthesiol 2004; 21:107.
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  6. Montes FR, Trillos JE, Rincón IE, et al. Comparison of total intravenous anesthesia and sevoflurane-fentanyl anesthesia for outpatient otorhinolaryngeal surgery. J Clin Anesth 2002; 14:324.
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  10. Twersky RS, Jamerson B, Warner DS, et al. Hemodynamics and emergence profile of remifentanil versus fentanyl prospectively compared in a large population of surgical patients. J Clin Anesth 2001; 13:407.
  11. Miller DR, Martineau RJ, O'Brien H, et al. Effects of alfentanil on the hemodynamic and catecholamine response to tracheal intubation. Anesth Analg 1993; 76:1040.
  12. Thompson JP, Hall AP, Russell J, et al. Effect of remifentanil on the haemodynamic response to orotracheal intubation. Br J Anaesth 1998; 80:467.
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  14. Jeon YT, Oh AY, Park SH, et al. Optimal remifentanil dose for lightwand intubation without muscle relaxants in healthy patients with thiopental coadministration: a prospective randomised study. Eur J Anaesthesiol 2012; 29:520.
  15. Demirkaya M, Kelsaka E, Sarihasan B, et al. The optimal dose of remifentanil for acceptable intubating conditions during propofol induction without neuromuscular blockade. J Clin Anesth 2012; 24:392.
  16. Stefanutto TB, Feiner J, Krombach J, et al. Hemoglobin desaturation after propofol/remifentanil-induced apnea: a study of the recovery of spontaneous ventilation in healthy volunteers. Anesth Analg 2012; 114:980.
  17. Gulhas N, Topal S, Erdogan Kayhan G, et al. Remifentanil without muscle relaxants for intubation in microlaryngoscopy: a double blind randomised clinical trial. Eur Rev Med Pharmacol Sci 2013; 17:1967.
  18. Mencke T, Jacobs RM, Machmueller S, et al. Intubating conditions and side effects of propofol, remifentanil and sevoflurane compared with propofol, remifentanil and rocuronium: a randomised, prospective, clinical trial. BMC Anesthesiol 2014; 14:39.
  19. Derrode N, Lebrun F, Levron JC, et al. Influence of peroperative opioid on postoperative pain after major abdominal surgery: sufentanil TCI versus remifentanil TCI. A randomized, controlled study. Br J Anaesth 2003; 9:842.
  20. De Baerdemaeker LE, Jacobs S, Pattyn P, et al. Influence of intraoperative opioid on postoperative pain and pulmonary function after laparoscopic gastric banding: remifentanil TCI vs sufentanil TCI in morbid obesity. Br J Anaesth 2007; 99:404.
  21. Bidgoli J, Delesalle S, De Hert SG, et al. A randomised trial comparing sufentanil versus remifentanil for laparoscopic gastroplasty in the morbidly obese patient. Eur J Anaesthesiol 2011; 28:120.
  22. Vuyk J. TCI: supplementation and drug interactions. Anaesthesia 1998; 53 Suppl 1:35.
  23. Pérus O, Marsot A, Ramain E, et al. Performance of alfentanil target-controlled infusion in normal and morbidly obese female patients. Br J Anaesth 2012; 109:551.
Courtesy of Dr. Vladimir Nekhendzy.
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