Recovery after remifentanil and sufentanil for analgesia and sedation of mechanically ventilated patients after trauma or major surgery

We investigated the analgesic effect and the neurological recovery time aft er administration of remifentanil in mechanically ventilated patients in an intensive care unit. Twenty patients, after trauma or major surgery with n o intracranial pathology, were randomized to receive either remifentanil/pr opofol (n=10) or sufentanil/propofol (n=10). A sedation score and a simplif ied pain score were used to assess adequate sedation and analgesia. Medicat ion was temporarily stopped after 24 h. Immediately before and 10 and 30 mi n after, the degree of sedation and pain score were evaluated. Adequate ana lgesia and sedation was achieved with remifentanil 10.6 mug kg(-1) h(-1) an d propofol 2.1 mg kg(-1) h(-1), or sufentanil 0.5 mug kg(-1) h(-1) and prop ofol 1.3 mg kg(-1) h(-1). The difference in propofol dose between groups wa s significant. Ten minutes after terminating the medication, the degree of sedation decreased significantly after remifentanil and all patients could follow simple commands. During the following 20 min, all patients with remi fentanil emerged from sedation and complained of considerable pain. By cont rast, in the sufentanil group, only six (7) responded to commands after 10 (30) min and their pain score remained essentially unchanged during the 30- min observation period. We conclude that, in contrast to sufentanil, remife ntanil facilitates rapid emergence from analgesia and sedation, allowing a clinical neurological examination within 10-30 min in mechanically ventilat ed patients with no intracranial pathology.