COMPARACIÓN ENTRE FENTANILO Y REMIFENTANILO EN LA PRÁCTICA ANESTÉSICA: UNA REVISIÓN BASADA EN EVIDENCIAS DE ENSAYOS CLÍNICOS ALEATORIZADOS
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https://doi.org/10.66104/f7w0py51Palabras clave:
Fentanilo, Remifentanilo, Anestesia, Analgesia perioperatoriaResumen
La elección racional entre fentanilo y remifentanilo en la práctica anestésica sigue siendo un tema controvertido, dadas las diferencias farmacocinéticas que impactan la eficacia analgésica y el perfil de seguridad perioperatorio. El presente estudio tuvo como objetivo analizar comparativamente la eficacia y seguridad de estos dos opioides sintéticos mediante una revisión integradora de la literatura. La búsqueda se realizó en las bases PubMed, EBSCO y MEDLINE, aplicando la estrategia PICO y el diagrama PRISMA, incluyendo ensayos clínicos aleatorizados publicados entre 2015 y 2025, en portugués o inglés. Se identificaron 407 registros, de los cuales 15 estudios cumplieron los criterios de elegibilidad y compusieron la muestra final, todos con nivel 2 de evidencia según la clasificación de la Agency for Healthcare Research and Quality. Los resultados demostraron que, en dosis sedantes tituladas durante anestesia general balanceada, fentanilo y remifentanilo presentaron eficacia analgésica y estabilidad hemodinámica equivalentes en pacientes adultos sanos. Sin embargo, el remifentanilo se asoció a mayor inestabilidad cardiovascular durante las transiciones farmacológicas, con hipotensión en la inducción y rebote hipertensivo en la emergencia, además de una elevada incidencia de depresión respiratoria (25%) en pacientes geriátricos bajo sedación consciente. El remifentanilo demostró ventaja en procedimientos ambulatorios de corta duración, siempre que se acople a una analgesia multimodal de transición. El fentanilo resultó preferible en cirugías de gran porte, pacientes neuroquirúrgicos y como adyuvante neuroaxial en anestesia obstétrica, debido a su analgesia residual prolongada. Las principales limitaciones incluyeron la escasez de comparaciones directas entre los dos fármacos, la heterogeneidad de los comparadores y el seguimiento temporal restringido al período de recuperación inmediata. Se concluye que fentanilo y remifentanilo constituyen herramientas farmacológicas complementarias, cuya selección debe fundamentarse en la individualización cuidadosa del paciente y del procedimiento.
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Derechos de autor 2026 Lucas Stêvão Oliveira Crêspo, José Ferreira de Sousa Netto, Wenno de Melo Cadete, Antonio Fernando de Souza Leão Neto, Wagner Breitner de Araujo Pinheiro Filho, João Gabriel Lucena Silva
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