Experience with remifentanil in a burns-care unit

During the consecutive treatment of severely burned patients, frequent periods of pain have been recorded. Therefore the use of potential short acting analgetic drugs are essential for the pain therapy during these periods. Remifentanil, a short acting opioid appears to have a promising profile of action for this application. Therefore the continuous administration of remifentanil for long-term analgesia on an intensive burn care unit was evaluated. For an evaluation period of 4 months, 31 severely burned patients were treated using remifentanil for analgesia. The total 265 of patient days was observed (mean 9 days per patient; min 2, max 24), We observed the whole treatment period starting with emergency care, intensive care as well as intraoperative treatment, The mean dosage necessary was 0.5 (min 0.1 - max 5) mg/h, In non-intubated patients (mean administered dose: 0.3 mg/h, min: 0.1 mg/h, max: 1.5 mg/h) no intubation or mechanical ventilation was necessary as the result of an opiate-overdosage. The mean cumulative dosage per day was 11.96 mg/24h and reached up to 153 mg/24h, No complications were observed due to the use of remifentanil, A sufficient analgesia could be achieved even though tachiphylaxis was observed, Due to its short time of action remifentanil was without any complication in intubated spontaneous breathing as well as in not-intubated patients in a critical care environment for analgesia of short but extremely painful periods. Additionally, remifentanil has been used successfully for intraoperative analgesia even after longterm administration. In summary remifentanil seems to be a valuable drug for long-term administration in the management of intubated and not-intubated patients on a burns care unit.