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KMID : 0869620140310040898
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Journal of Korean Society of Hospital Pharmacists
2014 Volume.31 No. 4 p.898 ~ p.907
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Dose Adjustment for Remifentanil with Regards to the Opioid-Sparing Effect of Dexmedetomidine in Critically Ill Patients
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Han Soo-Jung
Kim Hyung-Sook
Lee Jeong-Hwa
Lee Eun-Sook
Lee Yeon-Joo
Cho Young-Jae
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Abstract
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Background : Since the ‘analgosedation’was emerged as an important concept for critically ill patients, the recommendation for a combinational usage of remifentanil and dexmedetomidine as well as its usage has increased. Taking the opioid-sparing effect of dexmedetomidine into account, the dosage of remifentanil can be reduced if the combination of two drugs is used for the purpose of analgosedation which may consequently lead to the reduction of total drug costs. However, no tapering protocol of remifentanil in case of dexmedetomidine combined as sedative drug has been studied yet and there are no cost-effectiveness data for the opioid-sparing effect of dexmedetomidine.
Methods : A retrospective cohort analysis was done on patients treated with remifentanil and dexmedetomidine at the medical intensive care unit (MICU) of a tertiary teaching hospital from August 2013 to September 2013. The success rates of remifentanil reduction and cost reduction of analgesics were analyzed via the data of dosage and costs of remifentanil, dexmedetomidine and other rescue analgesics.
Results : Of 63 patients admitted to the MICU, 29 patients were treated with remifentanil and dexmedetomidine for analgosedation under mechanical ventilator care and 10 patients were treated with a half reduced dose of remifentanil. Eight (80%) patients succeeded in reducing their dose of remifentanil since the used Richmond Agitation-Sedation Scale showed scores between-2 and 0 and the numeric rating score for pain was maintained below 5. The rate of cost reduction
was 32.8% (from \159,059 to \105,283) in comparing the remifentanil-reduction succeeded group to the failed group (p=0.044). The overall rate of cost reduction was 26.9% in the whole remifentanil-reduction trial group.
Conclusions : The dose reduction of remifentanil was successfully achieved in critically ill patients under administration of remifentanil and dexmedetomidine, and it might be cost-effective. This study presents the possibility of an analgosedation adjustment that can be applied to MICU patients treated with both of dexmedetomidine and remifentanil.
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KEYWORD
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Analgosedation, Dexmedetomidine, Remifentanil, Opioid-sparing effect
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