Effects of remifentanil on brain responses to noxious stimuli during deep propofol sedation
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- dc.contributor.author Pujol Martí, Jesús
- dc.contributor.author Martínez-Vilavella, Gerard
- dc.contributor.author Gallart Gallego, Lluís
- dc.contributor.author Blanco Hinojo, Laura, 1981-
- dc.contributor.author Pacreu, Susana
- dc.contributor.author Bonhomme, Vincent
- dc.contributor.author Deus, Joan
- dc.contributor.author Pérez Solá, Victor
- dc.contributor.author Gambús, Pedro L.
- dc.contributor.author Fernández-Candil, Juan-Luis
- dc.date.accessioned 2023-01-20T07:46:18Z
- dc.date.available 2023-01-20T07:46:18Z
- dc.date.issued 2023
- dc.description.abstract Background: the safety of anaesthesia has improved as a result of better control of anaesthetic depth. However, conventional monitoring does not inform on the nature of nociceptive processes during unconsciousness. A means of inferring the quality of potentially painful experiences could derive from analysis of brain activity using neuroimaging. We have evaluated the dose effects of remifentanil on brain response to noxious stimuli during deep sedation and spontaneous breathing. Methods: optimal data were obtained in 26 healthy subjects. Pressure stimulation that proved to be moderately painful before the experiment was applied to the thumbnail. Functional MRI was acquired in 4-min periods at low (0.5 ng ml-1), medium (1 ng ml-1), and high (1.5 ng ml-1) target plasma concentrations of remifentanil at a stable background infusion of propofol adjusted to induce a state of light unconsciousness. Results: at low remifentanil doses, we observed partial activation in brain areas processing sensory-discriminative and emotional-affective aspects of pain. At medium doses, relevant changes were identified in structures highly sensitive to general brain arousal, including the brainstem, cerebellum, thalamus, auditory and visual cortices, and the frontal lobe. At high doses, no significant activation was observed. Conclusions: the response to moderately intense focal pressure in pain-related brain networks is effectively eliminated with safe remifentanil doses. However, the safety margin in deep sedation-analgesia would be narrowed in minimising not only nociceptive responses, but also arousal-related biological stress.
- dc.format.mimetype application/pdf
- dc.identifier.citation Pujol J, Martínez-Vilavella G, Gallart L, Blanco-Hinojo L, Pacreu S, Bonhomme V, et al. Effects of remifentanil on brain responses to noxious stimuli during deep propofol sedation. Br J Anaesth. 2023 130 (2): e330e-8. DOI: 10.1016/j.bja.2022.06.038.
- dc.identifier.doi http://dx.doi.org/10.1016/j.bja.2022.06.038
- dc.identifier.issn 0007-0912
- dc.identifier.uri http://hdl.handle.net/10230/55345
- dc.language.iso eng
- dc.publisher Elsevier
- dc.rights © 2022 Pujol J, Martínez-Vilavella G, Gallart L, Blanco-Hinojo L, Pacreu S, Bonhomme V, et al. Published by Elsevier Ltd on behalf of British Journal of Anaesthesia. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).
- dc.rights.accessRights info:eu-repo/semantics/openAccess
- dc.rights.uri http://creativecommons.org/licenses/by/4.0/
- dc.subject.keyword Deep sedation
- dc.subject.keyword Functional MRI
- dc.subject.keyword Neuroimaging
- dc.subject.keyword Nociception
- dc.subject.keyword Pain
- dc.subject.keyword Propofol
- dc.subject.keyword Remifentanil
- dc.title Effects of remifentanil on brain responses to noxious stimuli during deep propofol sedation
- dc.type info:eu-repo/semantics/article
- dc.type.version info:eu-repo/semantics/publishedVersion