중환자에서 Dexmedetomidine의 Opioid-Sparing Effect를 고려한 Remifentanil 용량 조절
Dose Adjustment for Remifentanil with Regards to the Opioid- Sparing Effect of Dexmedetomidine in Critically Ill Patients
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background : Since the ‘analgosedation’was emerged as an important concept forcritically ill patients, the recommendation for a combinational usage of remifentanil anddexmedetomidine as well as its usage has increased. Taking the opioid-sparing effect ofdexmedetomidine into account, the dosage of remifentanil can be reduced if the combination oftwo drugs is used for the purpose of analgosedation which may consequently lead to the reductionof total drug costs. However, no tapering protocol of remifentanil in case of dexmedetomidinecombined as sedative drug has been studied yet and there are no cost-effectiveness data for the opioid-sparing effect of dexmedetomidine. Methods : A retrospective cohort analysis was done on patients treated with remifentanil anddexmedetomidine at the medical intensive care unit (MICU) of a tertiary teaching hospital fromAugust 2013 to September 2013. The success rates of remifentanil reduction and cost reduction ofanalgesics were analyzed via the data of dosage and costs of remifentanil, dexmedetomidine andother rescue analgesics. Results : Of 63 patients admitted to the MICU, 29 patients were treated with remifentanil anddexmedetomidine for analgosedation under mechanical ventilator care and 10 patients weretreated with a half reduced dose of remifentanil. Eight (80%) patients succeeded in reducing theirdose of remifentanil since the used Richmond Agitation-Sedation Scale showed scores between-2and 0 and the numeric rating score for pain was maintained below 5. The rate of cost reductionwas 32.8% (from ￦159,059 to ￦105,283) in comparing the remifentanil-reduction succeeded groupto the failed group (p=0.044). The overall rate of cost reduction was 26.9% in the whole remifentanil-reduction trial group. Conclusions : The dose reduction of remifentanil was successfully achieved in critically illpatients under administration of remifentanil and dexmedetomidine, and it might be cost-effective. This study presents the possibility of an analgosedation adjustment that can be applied toMICU patients treated with both of dexmedetomidine and remifentanil.
Abstract
Background : Since the ‘analgosedation’was emerged as an important concept forcritically ill patients, the recommendation for a combinational usage of remifentanil anddexmedetomidine as well as its usage has increased. Taking the opioid-sparing effect ofdexmedetomidine into account, the dosage of remifentanil can be reduced if the combination oftwo drugs is used for the purpose of analgosedation which may consequently lead to the reductionof total drug costs. However, no tapering protocol of remifentanil in case of dexmedetomidinecombined as sedative drug has been studied yet and there are no cost-effectiveness data for the opioid-sparing effect of dexmedetomidine. Methods : A retrospective cohort analysis was done on patients treated with remifentanil anddexmedetomidine at the medical intensive care unit (MICU) of a tertiary teaching hospital fromAugust 2013 to September 2013. The success rates of remifentanil reduction and cost reduction ofanalgesics were analyzed via the data of dosage and costs of remifentanil, dexmedetomidine andother rescue analgesics. Results : Of 63 patients admitted to the MICU, 29 patients were treated with remifentanil anddexmedetomidine for analgosedation under mechanical ventilator care and 10 patients weretreated with a half reduced dose of remifentanil. Eight (80%) patients succeeded in reducing theirdose of remifentanil since the used Richmond Agitation-Sedation Scale showed scores between-2and 0 and the numeric rating score for pain was maintained below 5. The rate of cost reductionwas 32.8% (from ￦159,059 to ￦105,283) in comparing the remifentanil-reduction succeeded groupto the failed group (p=0.044). The overall rate of cost reduction was 26.9% in the whole remifentanil-reduction trial group. Conclusions : The dose reduction of remifentanil was successfully achieved in critically illpatients under administration of remifentanil and dexmedetomidine, and it might be cost-effective. This study presents the possibility of an analgosedation adjustment that can be applied toMICU patients treated with both of dexmedetomidine and remifentanil.
참고문헌 (14)
- Barr J., "Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit", Critical Care Medicine, 41, pp.263~306 (2013)
- Arain S.R., "The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery", Anesth Analg, 98, pp.153~158 (2004)
- Martin E, "The role of the a2-adrenoceptor agonist dexmedetomidine in postsurgical sedation in the intensive care unit", J Intensive Care Med, 18(1), pp.29~41 (2003)
- Elbaradie S, "Dexmedetomidine vs propofol for short-term sedation of postoperative mechanically ventilated patients", J Egypt Natl Canc Inst, 16, pp.153~158 (2004)
- Venn R.M., "Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit", Anaesthesia, 54, pp.1136~1142 (1999)
- Triltsch A. E., "Bispectral indexguided sedation with dexmedetomidine in intensive care: a prospective, randomized, double blind, placebo-controlled phase II study", Crit Care Med, 30, pp.1007~1014 (2002)
- Venn R.M, "Comparison between dexmedetomidine and propofol for sedation in the intensive care unit: patient and clinician perceptions", Br J Anaesth, 87, pp.684~690 (2001)
- Khan Z.P, "Alpha-2 and imidazoline receptor agonists. Their pharmacology and therapeutic role", Anaesthesia, 54, pp.146~165 (1999)
- Bhana N, "Dexmedetomidine", Drugs, 59, pp.263~270 (2000)
- Gelinas C., "Validation of the Critical-Care Pain Observation Tool in Adult Patients", Am J Crit Care, 15, pp.420~427 (2006)
- Parran L., "Effects of an opioid taper algorithm in hematopoietic progenitor cell transplant recipients", Oncology Nurs Forum, 29, pp.41~50 (2002)
- Franck L.S, "Naughton I. and Winter I.:Opioid and benzodiazepine withdrawal symptoms in paediatric intensive care patients", Intensive and Critical Care Nursing, 20, pp.344~351 (2004)
- 이경아, "원내 외과계 중환자실 재원 환자의 마약성 진통제 tapering현황 분석", 병원약사회지, 29(4), pp.384~393 (2012), 한국병원약사회
- Ebert T.J., "The effects of increasing plasma concentrations of dexmedetomidine in humans", Anesthesiology, 93(2), pp.382~394 (2000)