desflurane + remifentanil

The combination of desflurane and remifentanil is a balanced anesthesia approach used in various surgical procedures. This combination leverages the complementary properties of both agents to provide effective anesthesia with favorable recovery profiles. ## Pharmacological Properties Desflurane is a volatile inhalational anesthetic with low blood solubility, allowing for rapid induction and emergence from anesthesia[8]. Remifentanil is an ultra short-acting synthetic opioid with rapid onset and offset of action, making it ideal for continuous infusion during surgical procedures[5]. When used together, remifentanil reduces the required concentration of desflurane in a dose-dependent manner. Studies have shown that remifentanil at doses of 0.1, 0.15, or 0.25 μg/kg/min can reduce desflurane requirements by 74%, 83%, and 90% respectively[1]. This synergistic effect allows for lower concentrations of desflurane while maintaining adequate anesthesia. ## Clinical Applications The desflurane-remifentanil combination has been successfully used in various surgical settings: - General surgery and ambulatory procedures[6] - Otorhinolaryngeal surgery[7] - Tympanoplasty and endoscopic sinus surgery[4] - Cesarean section deliveries[3] - Laparoscopic procedures[6] ## Advantages This combination offers several clinical benefits: 1. **Improved hemodynamic stability**: The combination helps maintain stable blood pressure and heart rate during surgery[3]. 2. **Faster recovery**: Studies show shorter emergence times and faster achievement of discharge criteria compared to other anesthetic regimens[6][7]. 3. **Dose-dependent effects**: Remifentanil reduces desflurane requirements without increasing recovery time, allowing for tailored anesthesia[1][2]. 4. **Effective hypotensive anesthesia**: The combination provides good surgical conditions in terms of operative field quality, particularly beneficial in procedures where bleeding control is important[4]. ## Recommended Dosing For optimal results, studies recommend using remifentanil at 2 ng/ml or less combined with desflurane to decrease the concentration of desflurane without significant side effects during the maintenance phase of anesthesia[2]. Typical infusion rates range from 0.05 to 0.2 μg/kg/min for remifentanil alongside variable concentrations of desflurane (2-8%)[6]. ## Safety Considerations While generally well-tolerated, the combination may cause dose-dependent decreases in heart rate, particularly at higher remifentanil doses (0.15 or 0.25 μg/kg/min)[1]. However, studies have shown no significant differences in postoperative nausea and vomiting, pain, or the need for rescue medications compared to other anesthetic regimens[6]. In cesarean section procedures, the combination has been shown to be safe for both mother and newborn, with no significant impact on Apgar scores or umbilical artery blood pH values[3].

Other names

Desflurane with remifentanil