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Anaesthesia

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Local Anesthesia & Central Neuraxial Blockade

Question
116 out of 132
 

Which of the following agent is not given intrathecally in children for caudal anesthesia?



A Remifentanil
B Morphine

C Butorphanol
D Fentanyl

Ans. A

Remifentanil

Remifentanil is a formulation in glycine and water. This formulation is not used in central neural blockade. It is particularly useful as supplement in short procedures and in day care surgery.

Other salient points about Remifentanil:

The antidopiperidine opioid remifentanil has pharmacodynamic properties similar to all opioids; however, its pharmacokinetic characteristics are unique.

Remifentanil is metabolized by esterases that are widespread throughout the plasma, red blood cells, and interstitial tissues, whereas other anilidopiperidine opioids (e.g. fentanyl, alfentanil and sufentanil) depend upon hepatic biotransformation and renal excretion for elimination. Consequently, remifentanil is cleared considerably more rapidly than other anilidopiperidine opioids.

In addition, its pKa (the pH at which the drug is 50% ionised) is less than physiological pH; thus, remifentanil circulates primarily in the non-ionised moiety, which quickly penetrates the lipid blood-brain barrier and rapidly equilibrates across the plasma effect site interface.

Remifentanil, a clinically versatile opioid, is useful for intravenous analgesia and sedation in spontaneously breathing patients undergoing painful procedures. Profound analgesia may be achieved with minimal effect on cognitive function.

Remifentanil may also provide sedation and analgesia during placement of regional anaesthetic blocks, and in conjunction with topical anaesthesia and airway nerve blocks, it may be useful for blunting reflex responses and facilitating 'awake' fiberoptic intubation.

Compared with fentanyl and alfentanil in a day-surgery setting, remifentanil supplementation of general anaesthesia may improve intraoperative hemodynamic control.

Both emergence time and the incidence of respiratory depression during post-anaesthetic recovery may be reduced. However, outcomes such as home discharge time, post-emergence adverse effect profile, and patient and provider satisfaction are not significantly improved, and the incidence of intraoperative hypotension and bradycardia is greater.

Local Anesthesia & Central Neuraxial Blockade Flashcard List

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