Anesth Analg 1999;89:1561
© 1999 International Anesthesia Research Society
GENERAL ARTICLES
The Effect of Remifentanil on Biliary Tract Drainage into the Duodenum
Robert J. Fragen, MD*,
Fatima Vilich, MD*,
Stewart M. Spies, MD , and
William D. Erwin, MS
Departments of
*Anesthesiology and
Nuclear Medicine, Northwestern University Medical School, Chicago, Illinois
Address correspondence to Robert J. Fragen, MD, Department of Anesthesiology, Northwestern University Medical School, Rm 360 Passavant Pavilion, 303 E. Superior St., Chicago, IL 60611.
Opioids cause spasm of the sphincter of Oddi. Remifentanil is metabolized enzymatically throughout the body. Its context-sensitive half-time is 3–4 min. The effect of remifentanil on the sphincter of Oddi, is unknown. We studied, in six healthy adult volunteers, the effect of remifentanil on the flow of dye from the gall bladder into the duodenum. Control hepatobiliary imaging with 5 mCi of technetium-labeled derivatives of iminodiacetic acid was performed on each volunteer. The time from IV dye (radiopharmaceutical) injection until its appearance in the duodenum was determined by continuous scanning. Two weeks later, each volunteer received remifentanil, 0.1 µg · kg-1 · min-1 infused for 30 min IV before the same dose of technetium-labeled derivatives of iminodiacetic acid was injected, and for the time of their control scan plus 10 min after the injection. When the dye appeared in the duodenum, the total time from injection was compared with the control value. The time from stopping the infusion until the dye appeared in the duodenum was the "recovery time." Control scan time was 20.5 ± 9.9 min (mean ± SD; range 10–33 min). Total scan time during and after the remifentanil infusion was 50.3 ± 17.3 min (range 30–81 min) (P < 0002). The recovery time was 19.8 ± 12.4 min (range 5–40 min). We conclude that remifentanil delays the drainage of dye from the gall bladder into the duodenum, but the delay is shorter than that reported after other studied opioids.
Implications: Radioactive dye was injected IV into healthy volunteers to determine the time it took for the dye to appear in the duodenum. This was repeated under the influence of a short-acting narcotic analgesic, remifentanil. Remifentanil caused a much shorter delay than previously reported after morphine or meperidine.
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