Remifentanil for general anaesthesia: a systematic review

Summary We performed a quantitative systematic review of randomised, controlled trials that compared remifentanil to short-acting opioids (fentanyl, alfentanil, or sufentanil) for general anaesthesia. Eighty-five trials were identified and these included a total of 13 057 patients. Intra-operatively, remifentanil was associated with clinical signs of deeper analgesia and anaesthesia, such as fewer responses to noxious stimuli (relative risk 0.65, 95% CI 0.48‐0.87), more frequent episodes of bradycardia (1.46, 1.04‐2.05), more hypotension (1.68, 1.36‐2.07) and less hypertension (0.60, 0.46‐0.78). Postoperatively, remifentanil was associated with faster recovery (difference in extubation time of )2.03, 9.5% CI, )2.92 to )1.14 min), more frequent postoperative analgesic requirements (1.36, 1.21‐1.53) and fewer respiratory events requiring naloxone (0.25, 0.14‐0.47). Remifentanil had no overall impact on postoperative nausea (1.03, 0.97‐1.09) or vomiting (1.06, 0.96‐1.17), but was associated with twice as much shivering (2.15, 1.73‐2.69). Remifentanil does not seem to offer any advantage for lengthy, major interventions, but may be useful for selected patients, e.g. when postoperative respiratory depression is a concern.