Remifentanil vs Morphine for Patients in Intensive Care
Unit Who Need Short-Term Mechanical Ventilation
THITIMA CHINACHOTI, M.D.*, PETER KESSLER, M.D., Ph.D.**,
ANDREW KIRKHAM, M.D.***, THEWARUG WERA WATGANON, M.D.****
Affiliation : * Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
** University of Frankfurt, Germany.
*** GlaxoSmithKiine, Greenford, United Kingdom.
**** Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
AbstractThis randomized, double-blind study compared the safety and efficacy of remifentanil (9 ).lg/
kg/h) with morphine (0.045 mg/kglh plus a bolus dose of 0.025 mg/kg). One hundred and eighty nine
Intensive Care Unit (ICU) patients with normal renal function or mild renal impairment requiring
mechanical ventilation were included in this study. A pre-defined dosing algorithm permitted initial
titration of the opioids to predetermine the optimal level of sedation and pain score. Supplementary
infusion of midazolam (0.03 mg/kglh) was given when additional sedation was required. The duration
of optimal sedation during the maintenance phase was 82.7 per cent and 84.3 per cent of the total
time in the remifentanil and morphine groups respectively. There were no statistically significant
differences in the between-subject variability in the duration of optimal sedation between the two
treatment groups. Midazolam was not required in approximately 75 per cent of all patients. The patients
in the morphine group required twice the amount of midazolam required by the remifentanil group.
The dosing algorithm facilitated rapid extubation in both groups. Remifentanil provided comparable
hemodynamic stability to morphine, and was not associated with an increase in cardiovascular adverse
event. Remifentanil is therefore considered to be effective and well tolerated in ICU patients.
Keywords : Intensive Care Unit, Mechanical Ventilation, Sedation and Analgesia, Remifentanil,
Morphine
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