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Farmacologische interactie tussen dexmedetomidine en remifentanil

(2018) Been, D.

Introduction: Dexmedetomidine is a newer specific alfa-2-receptoragonist with growing popularity for the Intensive Care unit and as a narcotic during operations. Advantages are sedative, analgesic and anxiolytic features with minimal influence on respiration. Research has shown us that, although dexmedetomidine is an effective sedative, therapeutic concentrations resulting in mild to deep sedations seem to lack analgesic efficacy. Remifentanil does have strong analgesic properties, but is not an adequate sedative. The aim of this study is to investigate the sedative properties of dexmedetomidine and the interaction with remifentanil.
Method: thirty healthy volunteers received dexmedetomidine through Target Controlled Infusion with an effect-site target of 2.0 ng/mL. The level of sedation is measured through Patient State Index (PSI), reaction to shake and shout (TOSS) and reaction to laryngoscopy (TOL). These measures are repeated after adding and increasing concentrations of remifentanil to an effect-site target of 1.0 and 4.0 ng/mL. The 99% confidence interval for difference in proportion will be used to test differences in TOSS and TOL. Differences in PSI values are tested with an independent t-test. A p-value <0,01 was considered statistically significant.
Results: In comparison with dexmedetomidine only, a significant increase in toleration for laryngoscopy is seen after adding remifentanil in the highest concentration to dexmedetomidine. Adding remifentanil does not lead to a higher proportion volunteers who tolerate shake and shout, independent of the concentration remifentanil. No significance difference is seen in PSI-value.
Discussion: Although remifentanil is not a hypnotic in the clinically relevant concentration range, it profoundly decreases the dexmedetomidine concentration for loss of response to laryngoscopy. There appears to be a high interindividual variability in the level of sedation induced by dexmedetomidine, further research has to be done to find out the optimal dosages of dexmedetomidine and remifentanil.






 
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