This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (12) Citing Articles via Google Scholar Google Scholar Articles by Noseir, R. K. Articles by Ebert, T. J. Search for Related Content PubMed PubMed Citation Articles by Noseir, R. K. Articles by Ebert, T. J. Related Collections Cardiovascular Pharmacology

---

ANESTHETIC PHARMACOLOGY

Sympathetic and Vascular Consequences from Remifentanil in Humans

Department of Anesthesiology, Medical College of Wisconsin and Veterans Affairs Medical Center, Milwaukee

Address correspondence to Thomas J. Ebert, MD, PhD, VA Medical Center/112A, 5000 West National Ave., Milwaukee, WI 53295. Address e-mail to tjebert{at}mcw.edu

We explored the possible mechanisms of hypotension during the administration of sedation-analgesia doses of remifentanil in young (ASA physical status I) volunteers (n = 24). Cardiorespiratory and sympathetic variables were collected at baseline and at plasma concentrations of remifentanil (2 and 4 ng/mL). Monitoring included electrocardiogram, heart rate (HR), direct blood pressure, muscle sympathetic nerve activity, and forearm blood flow (FBF). A cold pressor test (1-min hand immersion in ice water) quantified analgesia effectiveness (visual analog scale, 0–100). Visual analog scale to the cold pressor test (62 at baseline) decreased to 27 and 18 during remifentanil infusions. Respiratory rate decreased and end-tidal carbon dioxide (ETCO₂) increased with increasing doses of remifentanil; HR, direct blood pressure, muscle sympathetic nerve activity, SpO₂ remained unchanged, but FBF increased compared with placebo. In a second study (n = 7), timed respiration was used to maintain ETCO₂ during remifentanil, but FBF still increased. In a third study (n = 11), direct effects of remifentanil on vascular tone were determined with progressive infusions from 1 to 100 µg/h into the brachial artery; FBF increased significantly from 3.5 to 4.3 mL/min per 100 mL of tissue (13%–18% increase). Sedative doses of remifentanil resulted in analgesia but no changes in neurocirculatory end-points except FBF. Direct effects of remifentanil on regional vascular tone may play a role in promoting hypotension.

IMPLICATIONS: Remifentanil occasionally has been associated with hypotension, the mechanism of which is unclear. This study found that remifentanil directly causes the forearm arterial vasculature to dilate.

This article has been cited by other articles:

				E. A. ten Brinke, R. J. Klautz, S. A. Tulner, F. H. Engbers, H. F. Verwey, D. E. Atsma, M. J. Schalij, E. E. van der Wall, J. J. Bax, H. Putter, et al. Haemodynamics and left ventricular function in heart failure patients: Comparison of awake versus intra-operative conditions Eur J Heart Fail, May 1, 2008; 10(5): 467 - 474. [Abstract] [Full Text] [PDF]

				V. Nekhendzy, H. J. M. Lemmens, W. C. Vaughan, E. J. Hepworth, A. G. Chiu, C. A. Church, and J. G. Brock-Utne The Effect of Deliberate Hypercapnia and Hypocapnia on Intraoperative Blood Loss and Quality of Surgical Field During Functional Endoscopic Sinus Surgery Anesth. Analg., November 1, 2007; 105(5): 1404 - 1409. [Abstract] [Full Text] [PDF]

				P. Lecomte, A. Ouattara, Y. Le Manach, M. Landi, P. Coriat, and B. Riou The Coronary and Myocardial Effects of Remifentanil and Sufentanil in the Erythrocyte-Perfused Isolated Rabbit Heart. Anesth. Analg., July 1, 2006; 103(1): 9 - 14. [Abstract] [Full Text] [PDF]

				A. D. Kaye, A. Baluch, J. Phelps, S. R. Baber, I. N. Ibrahim, J. M. Hoover, C. Zhang, and A. Fields An Analysis of Remifentanil in the Pulmonary Vascular Bed of the Cat Anesth. Analg., January 1, 2006; 102(1): 118 - 123. [Abstract] [Full Text] [PDF]

				T. J. Ebert, D. J. Ficke, S. R. Arain, M. N. Holtz, and H. Shankar Vasodilation from Sufentanil in Humans Anesth. Analg., December 1, 2005; 101(6): 1677 - 1680. [Abstract] [Full Text] [PDF]

				I. Schafhalter-Zoppoth, I. D. Zeitz, and A. T. Gray Inadvertent Femoral Nerve Impalement and Intraneural Injection Visualized by Ultrasound Anesth. Analg., August 1, 2004; 99(2): 627 - 628. [Full Text] [PDF]