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Review
. 2023 May;78(5):620-625.
doi: 10.1111/anae.15952. Epub 2022 Dec 23.

Alternatives to remifentanil for the analgesic component of total intravenous anaesthesia: a narrative review

L M Hughes  1 , M G Irwin  2 , C C Nestor  1
Affiliations
Free article
Review

Alternatives to remifentanil for the analgesic component of total intravenous anaesthesia: a narrative review

L M Hughes et al. Anaesthesia. 2023 May.
Free article

Abstract

Propfol-remifentanil-based total intravenous anaesthesia has dominated recent clinical practice due to its favourable pharmacokinetic profile. Interruption in remifentanil supply has presented an opportunity to diversify or even avoid the use of opioids and consider adjuncts to propofol-based total intravenous anaesthesia. Propofol, while a potent hypnotic, is not an effective analgesic. The administration of opioids, along with other adjuncts such as α-2 adrenoceptor agonists, magnesium, lidocaine, ketamine and nitrous oxide provide surgical anaesthesia and avoids large doses of propofol being required. We provide an overview of both target-control and manual infusion regimes for the alternative opioids: alfentanil, sufentanil and fentanyl. The optimal combination of hypnotic-opioid dose, titration sequence and anticipated additional postoperative analgesia required depend on the chosen combination. In addition, we include a brief discussion on the role of non-opioid adjuncts in total intravenous anaesthesia, suggested doses and expected reduction in propofol dose.

Keywords: CSHT; Gepts; Maitre; Scott; TCI; TIVA; alfentanil; fentanyl; remifentanil; sufentanil.

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References

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    1. Nimmo AF, Absalom AR, Bagshaw O, et al. Guidelines for the safe practice of total intravenous anaesthesia (TIVA): Joint Guidelines from the Association of Anaesthetists and the Society for Intravenous Anaesthesia. Anaesthesia 2019; 74: 211-24.
    1. Irwin MG, Wong GTC, Wan LS. Taking on TIVA. Hong Kong: Cambridge University Press, 2020.
    1. Gepts E, Jonckheer K, Maes V, Sonck W, Camu F. Disposition kinetics of propofol during alfentanil anaesthesia. Anaesthesia 1988; 43: 8-13.

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