Despite the growing interest in remifentanil for endoscopic procedures, available data are conflicting. Objective. To evaluate efficacy and safety of remifentanil and fentanyl for analgesia in adults undergoing endoscopic procedures. Material and methods. Nine biomedical databases were screened regarding randomized controlled trials (RCTs) involving remifentanil or fentanyl as components of analgesia for endoscopic procedures under spontaneous breathing in adults. Primary endpoints included procedural measures (time to induction, recovery and complete recovery, achievement of discharge criteria), incidence of intraoperative respiratory depression and postoperative pain. The review was conducted in accordance with the PRISMA 2020 guidelines. Results. Meta-analysis included 16 RCTs (1.242 patients). Remifentanil provided faster induction (MD –1.47 min, 95% CI –2.27 to –0.68, p=0.0003) and awakening (MD –2.98 min, 95% CI –4.25 to –1.72, p<0.00001) compared to fentanyl. Remifentanil provided earlier complete recovery (MD –5.64 min, 95% CI –7.67 to –3.61, p<0.00001) and complete recovery for discharge (MD –22.24 min, 95% CI –26.91 to –17.57, p<0.00001). Remifentanil was associated with a trend towards higher risk of respiratory depression compared to fentanyl, but the difference was insignificant (RR=1.25; 95% CI 0.89 to 1.75; p=0.19). Both opioids had equivalent profiles in terms of blood pressure control, bradycardia risk, and postoperative pain. Conclusion. Remifentanil significantly reduces time to induction, recovery and complete recovery, as well as achievement of discharge criteria in endoscopic procedures in adults. However, these results are preliminary due to low certainty of evidence (GRADE ). When using remifentanil, strict monitoring of gas exchange and readiness for mechanical ventilation are necessary. Further randomized controlled trials are needed to determine optimal dose of remifentanil, especially in high-risk patients.
N. Barkovskaya, E. Shifman, D. Protsenko et al.· Russian Journal of Anesthesi...· 0 citations
INTRODUCTION: Older age is recognized as an independent risk factor for adverse perioperative outcomes; however, quantitative data on the impact of early old age (65–75 years) on 30-day postoperative complications in a multicenter Russian cohort are lacking. OBJECTIVE: To determine whether older age (65–75 years) is associated with the incidence, pattern, severity, and timing of 30-day postoperative complications and mortality compared with patients aged 18–64 years undergoing elective abdominal surgery. MATERIALS AND METHODS: A multicenter prospective cohort study was conducted (secondary analysis of the STOPRISK database, NCT03945968; STROBE). From 2019 to 2024, 12,000 patients from 38 centers across the Russian Federation were enrolled. After exclusions, the analytical sample comprised 10,915 patients: 18–64 years (n = 8,119) and 65–75 years (n = 2,796). The primary outcome was any 30-day postoperative complication (ESA/ESICM). Secondary outcomes were 30-day mortality, complication severity (Clavien-Dindo), and timing of occurrence. RESULTS: The 30-day complication rate in patients aged 65–75 years was more than twice that in the 18–64-year group (7.15 vs 3.09 %), and 30-day mortality was more than threefold higher (1.18 vs 0.33 %). The greatest relative risk increase was observed for postoperative delirium (RR 7.55), acute myocardial infarction (RR 5.08), arrhythmias (RR 4.26), and acute kidney injury (RR 3.87). The distribution of complication severity according to Clavien-Dindo did not differ between groups, most complications in both groups occurred within the first 5 days. After multivariable adjustment, older age remained an independent predictor of any complications, severe complications, and mortality. CONCLUSIONS: Older age (65–75 years) is an independent predictor of postoperative complications and mortality following elective abdominal surgery, increasing the risk of complications 1.7-fold and the risk of death 2.2-fold after confounder adjustment. The identified profile of high-risk specific complications supports the need for targeted perioperative management protocols in elderly patients.
I. Zabolotskikh, T. S. Musaevа, M. A. Magomedov et al.· Annals of Critical Care· 0 citations
