Bürkle H, Dunbar S, Van Aken H
Department of Anesthesiology and Intensive Care Medicine, Westfälische Wilhelms-Universität, Münster, Germany.
Anesth Analg. 1996 Sep;83(3):646-51. doi: 10.1097/00000539-199609000-00038.
Because of remifentanil's unique pharmacokinetics, its systemic administration may be suitable for clinical settings where a potent, fast-acting, systemic mu-opioid with a rapid recovery is required, e.g., short painful intervention in the emergency room or the intensive care unit, or procedures in the day surgery or endoscopy suite. Total intravenous anesthesia for longer lasting procedures may become more promising because of the predictability of the offset of remifentanil even after long infusions. Its closest competitor, alfentanil, depends on its small volume of distribution for rapid termination of its effect, but still possesses the potential to accumulate because of its relatively long terminal elimination half-life. Remifentanil might be the first potent mu-opioid that does not accumulate in this fashion, and therefore it opens promising new clinical perspectives (52). However, as mentioned above, the relative short-lasting analgesic effect after cessation of the remifentanil infusion might require new, sophisticated techniques from the anesthetist to prevent immediate onset of postoperative pain.
由于瑞芬太尼独特的药代动力学特性，其全身给药可能适用于需要强效、速效、全身作用且恢复迅速的μ阿片类药物的临床情况，例如急诊室或重症监护病房的短期疼痛干预，或日间手术或内镜检查室的操作。对于持续时间较长的手术，全凭静脉麻醉可能会更具前景，因为即使长时间输注瑞芬太尼，其作用消退也具有可预测性。其最接近的竞争对手阿芬太尼，其作用的快速终止依赖于其较小的分布容积，但由于其相对较长的终末消除半衰期，仍有蓄积的可能性。瑞芬太尼可能是首个不会以这种方式蓄积的强效μ阿片类药物，因此它开辟了有前景的新临床前景（52）。然而，如上文所述，停止输注瑞芬太尼后相对短暂的镇痛效果可能需要麻醉医生采用新的、复杂的技术来预防术后疼痛的立即发作。
