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Remifentanil, fentanyl, or the combination in surgical procedures in the United States: predictors of use in patients with organ impairment or obesity.

Sclar DA - Clin Drug Investig (2015)

Bottom Line: In obese patients, the probability of remifentanil use was greater for persons aged >50 years or female (both p < 0.05).This is inconsistent with the fact that the pharmacokinetic/pharmacodynamic features of remifentanil suggest it is the preferred intraoperative opioid in these patients.Remifentanil in combination with fentanyl was significantly less utilized than fentanyl in persons with Medicaid as primary payer even though there was a disproportionate enrollment of beneficiaries with renal or hepatic disease, or obesity in state Medicaid programs.

View Article: PubMed Central - PubMed

Affiliation: College of Pharmacy, Midwestern University, Glendale, AZ, USA, dsclar@midwestern.edu.

ABSTRACT

Introduction: Remifentanil has a rapid onset and short duration of action, predictable pharmacokinetic/pharmacodynamic profile, and unlike fentanyl, does not accumulate with repeated or prolonged administration. This study evaluated predictors of remifentanil use in surgical patients with renal or hepatic impairment, or obesity in the United States who received remifentanil, fentanyl, or the combination.

Methods: Data (2010) from the US Healthcare National Inpatient Database, State Inpatient Database, State Ambulatory Surgery Database, and private hospital and Medicaid databases were used in this analysis. Patients included had presence of hepatic or renal disease, and/or obesity and were >5 and ≤80 years of age.

Results: In 2010, 9,274 patients with renal impairment, 1,896 with hepatic impairment, and 6,278 with obesity were identified. The percentage of surgical patients diagnosed with renal disease, hepatic disease, or obesity who received remifentanil was 41, 28, and 35%, respectively; 29, 17, and 22% received both remifentanil and fentanyl, and 30, 55, and 43% received fentanyl alone, respectively. In patients with renal or hepatic disease the probability of remifentanil use was greater for persons aged >50 years, with Medicare as primary payer, or who were diagnosed with obesity (p < 0.05 all comparisons). In obese patients, the probability of remifentanil use was greater for persons aged >50 years or female (both p < 0.05). For all 3 disease states, the probability of remifentanil use was lower for those receiving epidural anesthesia or with Medicaid as primary payer (p < 0.05 all comparisons).

Conclusion: Remifentanil in combination with fentanyl is used less than fentanyl in surgical patients with hepatic impairment or obesity. This is inconsistent with the fact that the pharmacokinetic/pharmacodynamic features of remifentanil suggest it is the preferred intraoperative opioid in these patients. Predictors of remifentanil use in patients with renal or hepatic impairment, or obesity include older age, obesity, and Medicare as primary payer. Remifentanil in combination with fentanyl was significantly less utilized than fentanyl in persons with Medicaid as primary payer even though there was a disproportionate enrollment of beneficiaries with renal or hepatic disease, or obesity in state Medicaid programs.

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Related in: MedlinePlus

Percentage of renal-impaired, hepatic-impaired, or obese patients receiving remifentanil, fentanyl, or a combination of remifentanil and fentanyl
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Fig1: Percentage of renal-impaired, hepatic-impaired, or obese patients receiving remifentanil, fentanyl, or a combination of remifentanil and fentanyl

Mentions: Of the patients identified with renal impairment, 41 % received remifentanil, 29 % received a combination of remifentanil and fentanyl, and 30 % received fentanyl alone (Fig. 1). Twenty-eight percent of the patients identified with hepatic impairment received remifentanil, while 17 % received the combination of the two drugs and 55 % received fentanyl alone. Among the obese patients, 35, 22, and 43 % received remifentanil, a combination of remifentanil and fentanyl, or fentanyl alone, respectively.Fig. 1


Remifentanil, fentanyl, or the combination in surgical procedures in the United States: predictors of use in patients with organ impairment or obesity.

Sclar DA - Clin Drug Investig (2015)

Percentage of renal-impaired, hepatic-impaired, or obese patients receiving remifentanil, fentanyl, or a combination of remifentanil and fentanyl
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4281365&req=5

Fig1: Percentage of renal-impaired, hepatic-impaired, or obese patients receiving remifentanil, fentanyl, or a combination of remifentanil and fentanyl
Mentions: Of the patients identified with renal impairment, 41 % received remifentanil, 29 % received a combination of remifentanil and fentanyl, and 30 % received fentanyl alone (Fig. 1). Twenty-eight percent of the patients identified with hepatic impairment received remifentanil, while 17 % received the combination of the two drugs and 55 % received fentanyl alone. Among the obese patients, 35, 22, and 43 % received remifentanil, a combination of remifentanil and fentanyl, or fentanyl alone, respectively.Fig. 1

Bottom Line: In obese patients, the probability of remifentanil use was greater for persons aged >50 years or female (both p < 0.05).This is inconsistent with the fact that the pharmacokinetic/pharmacodynamic features of remifentanil suggest it is the preferred intraoperative opioid in these patients.Remifentanil in combination with fentanyl was significantly less utilized than fentanyl in persons with Medicaid as primary payer even though there was a disproportionate enrollment of beneficiaries with renal or hepatic disease, or obesity in state Medicaid programs.

View Article: PubMed Central - PubMed

Affiliation: College of Pharmacy, Midwestern University, Glendale, AZ, USA, dsclar@midwestern.edu.

ABSTRACT

Introduction: Remifentanil has a rapid onset and short duration of action, predictable pharmacokinetic/pharmacodynamic profile, and unlike fentanyl, does not accumulate with repeated or prolonged administration. This study evaluated predictors of remifentanil use in surgical patients with renal or hepatic impairment, or obesity in the United States who received remifentanil, fentanyl, or the combination.

Methods: Data (2010) from the US Healthcare National Inpatient Database, State Inpatient Database, State Ambulatory Surgery Database, and private hospital and Medicaid databases were used in this analysis. Patients included had presence of hepatic or renal disease, and/or obesity and were >5 and ≤80 years of age.

Results: In 2010, 9,274 patients with renal impairment, 1,896 with hepatic impairment, and 6,278 with obesity were identified. The percentage of surgical patients diagnosed with renal disease, hepatic disease, or obesity who received remifentanil was 41, 28, and 35%, respectively; 29, 17, and 22% received both remifentanil and fentanyl, and 30, 55, and 43% received fentanyl alone, respectively. In patients with renal or hepatic disease the probability of remifentanil use was greater for persons aged >50 years, with Medicare as primary payer, or who were diagnosed with obesity (p < 0.05 all comparisons). In obese patients, the probability of remifentanil use was greater for persons aged >50 years or female (both p < 0.05). For all 3 disease states, the probability of remifentanil use was lower for those receiving epidural anesthesia or with Medicaid as primary payer (p < 0.05 all comparisons).

Conclusion: Remifentanil in combination with fentanyl is used less than fentanyl in surgical patients with hepatic impairment or obesity. This is inconsistent with the fact that the pharmacokinetic/pharmacodynamic features of remifentanil suggest it is the preferred intraoperative opioid in these patients. Predictors of remifentanil use in patients with renal or hepatic impairment, or obesity include older age, obesity, and Medicare as primary payer. Remifentanil in combination with fentanyl was significantly less utilized than fentanyl in persons with Medicaid as primary payer even though there was a disproportionate enrollment of beneficiaries with renal or hepatic disease, or obesity in state Medicaid programs.

Show MeSH
Related in: MedlinePlus