A comparison of the remifentanil and fentanyl adverse effect profile in a multicenter phase IV study

Girish P. Joshi, David S. Warner, Rebecca S. Twersky, Lee A. Fleisher

Research output: Contribution to journalArticle

Abstract

Study Objective: To compare the frequency of adverse effects of remifentanil and fentanyl in a large and diverse patient population. Design: Prospective, randomized, open-label study. Setting: Multicenter study including academic and community hospitals. Patients: 2,438 adult patients (1,496 outpatients and 942 inpatients) scheduled for elective surgical procedures under general endotracheal anesthesia of at least 30-minute duration. Interventions: Patients were randomly assigned to receive either intravenous (IV) remifentanil (n = 1,229) 0.5 μg/kg/min for induction and tracheal intubation followed by an infusion rate of 0.25 μg/kg/min or fentanyl (n = 1,209) administered according to the anesthesiologist's usual practice. Anesthesia was maintained with propofol and/or isoflurane (with or without nitrous oxide) titrated according to protocol. Transition analgesia with either morphine or fentanyl was administered in the remifentanil and, at the anesthesiologist's discretion, in the fentanyl group. Measurements: The overall nonspecific and specific (i.e., opioid-related) adverse effects were recorded. Main Results: Remifentanil was associated with more intraoperative hypotension than fentanyl (p<0.05). All four cases (0.3%) of muscle rigidity occurred in the remifentanil-treated outpatients. There were no significant differences between the two drugs with respect to other adverse events (i.e., episodes of hypertension, bradycardia, respiratory depression, and apnea). Conclusions: In the doses used, both remifentanil and fentanyl have a similar frequency of adverse effects except for the higher frequency of hypotension associated with the use of remifentanil.

Original languageEnglish (US)
Pages (from-to)494-499
Number of pages6
JournalJournal of Clinical Anesthesia
Volume14
Issue number7
DOIs
StatePublished - Nov 2002

Fingerprint

Fentanyl
Hypotension
Endotracheal Anesthesia
Outpatients
Elective Surgical Procedures
Muscle Rigidity
Isoflurane
Community Hospital
Nitrous Oxide
Propofol
Apnea
Bradycardia
remifentanil
Intubation
Respiratory Insufficiency
Analgesia
General Anesthesia
Morphine
Opioid Analgesics
Multicenter Studies

Keywords

  • Adverse effects
  • Anesthesia
  • Fentanyl
  • General
  • Humans
  • Remifentanil

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

A comparison of the remifentanil and fentanyl adverse effect profile in a multicenter phase IV study. / Joshi, Girish P.; Warner, David S.; Twersky, Rebecca S.; Fleisher, Lee A.

In: Journal of Clinical Anesthesia, Vol. 14, No. 7, 11.2002, p. 494-499.

Research output: Contribution to journalArticle

Joshi, Girish P. ; Warner, David S. ; Twersky, Rebecca S. ; Fleisher, Lee A. / A comparison of the remifentanil and fentanyl adverse effect profile in a multicenter phase IV study. In: Journal of Clinical Anesthesia. 2002 ; Vol. 14, No. 7. pp. 494-499.
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