Author: Ethan Covey
The use of remifentanil in patients undergoing flexible bronchoscopy resulted in no change in the length of stay in the PACU, despite worse ASA status and greater case complexity, according to a new study. The researchers also found that PACU length of stay was unchanged in rigid bronchoscopy patients who received remifentanil, despite a nearly 50% increase in duration of the operation.
“This project began in 2013, when remifentanil began to first be utilized for this type of procedure,” said Troy G. Seelhammer, MD, an anesthesiologist in the Department of Anesthesiology and Perioperative Medicine at Mayo Clinic in Rochester, Minn. “At the time, the concept was that remifentanil, being a very short-acting and predictable agent for procedural analgesia, could smooth the hemodynamic profile and facilitate a rapid emergence from anesthesia at the end of the case.”
Dr. Seelhammer and his colleagues conducted a retrospective review of medical records of patients who underwent rigid or flexible bronchoscopy, and received monitored anesthesia care (MAC) with remifentanil or non-remifentanil opioids for sedation or analgesia between Jan. 1, 2013 and March 1, 2018. The primary outcome of the study was duration of PACU stay. Secondary outcomes included time to extubation, intraoperative hemodynamics, intraoperative oxygenation and ventilation, and complications including prolonged intubation, need for reintubation and unplanned ICU admission.
The researchers found that use of remifentanil during MAC for flexible bronchoscopy made no difference in PACU length of stay, even though patients in the group had worse ASA status, greater case complexity and longer surgical duration. In addition, in the rigid bronchoscopy group, the PACU length of stay remained unchanged in patients receiving remifentanil despite a nearly 50% increase in operating time.
“The unique pharmacokinetics of remifentanil may facilitate anesthetic management for more comorbid patients and complex, prolonged bronchoscopy procedures without prolongation of postprocedural length of stay,” Dr. Seelhammer said.
“This study confirms the known drawback of the use of remifentanil in this and other patient populations—namely more hypotension—and the lack of the anticipated benefits in shortening the time to extubation, PACU length of stay [and] rate of reintubation as was initially thought,” Dr. Abdelmalak said. “Perhaps remifentanil is not the appropriate agent for these procedures, and alternatives should be considered.”
Dr. Seelhammer said he is hopeful the data will lead to additional research into the cost-effectiveness of remifentanil, and to further study of the “unique patient factors and individual bronchoscopy procedures that may benefit the most from the addition of remifentanil, and may improve the ability to apply this approach most effectively to optimize patient outcomes.”