보험인정기준 상세내용

■ 고시 신설/개정 전체내용

허가사항 범위 내에서 아래와 같은 기준으로 투여시 요양급여를 인정하며, 동 인정기준 이외에는 약값 전액을 환자가 부담토록 함

- 아 래 -

가. 마취유도 및 마취유지의 진통에 투여 시

1) 2시간 이내 사용량

2) 간·신부전환자, 심장·뇌질환자, 암환자, 희귀난치성질환자에게 사용한 경우

나. 기계적 환기를 실시중인 중환자의 진통 및 진정(18세 이상)에 투여시

○ 3일 이내 사용량(1일 최대 15mg)까지 인정함



■ 고시 신설/개정 고시번호(시행일자)

고시 제2016-203호(2016.11.1.)



■ 고시 신설/개정 사유

허가사항, 교과서,가이드라인 및 임상연구문헌 등을 참고하여 기계적 환기를 실시중인 중환자의 진통 및 진정에 급여범위를 확대함



■ 관련문헌 등(*필요시 생략 가능)

· Goodman and Gilman's the pharmacological basis of therapeutics, 12th. 2013. Chapter 18. Opioids, Analgesia, and Pain Management

· Miller: Miller's Anesthesia, 8th ed. 2015. Chapter 31 - Opioids Analgesics

· Martindale, 37th ed. Analgesics Anti-inflammatory Drug and Antipyretics

· Textbook of Critical Care, Sixth Edition 2011, 184. Opioids

· 대한마취통증의학회, 마취통증의학 3판 (2014년)

· Anesthesia UK update (16/6/2007) Pharmacology of Opioids II(opioids)

· Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013 Jan.

· 대한중환자의학회, 2010 성인중환자실에서 진정, 진통의 임상진료지침

· Greco M, et al, Remifentanil in cardiac surgery: a meta-analysis of randomized controlled trials. J Cardiothorac Vasc Anesth. 2012 Feb;26(1):110-6

· Tan JA, et al, Use of remifentanil as a sedative agent in critically ill adult patients: a meta-analysis. Anaesthesia. 2009 Dec;64(12):1342-52

· Rozendaal FW, et al, Remifentanil-propofol analgo-sedation shortens duration of ventilation and length of ICU stay compared to a conventional regimen: a centre randomised, cross-over, open-label study in the Netherlands. Intensive Care Med. 2009 Feb;35(2):291-8.

· Muellejans B, Sedation in the intensive care unit with remifentanil/propofol versus midazolam/fentanyl: a randomised, open-label, pharmacoeconomic trial. Crit Care. 2006;10(3):R91.

· Breen D, et al, Decreased duration of mechanical ventilation when comparing analgesia-based sedation using remifentanil with standard hypnotic-based sedation for up to 10 days in intensive care unit patients: a randomised trial. Crit Care. 2005 Jun;9(3):R200-10.

· Baillard C, et al, Remifentanil-midazolam compared to sufentanil-midazolam for ICU long-term sedation, Ann Fr Anesth Reanim. 2005 May;24(5) 24 480？486

· Karabinis A, et al, Safety and efficacy of analgesia-based sedation with remifentanil versus standard hypnotic-based regimens in intensive care unit patients with brain injuries: a randomised, controlled trial. Crit Care. 2004 Aug;8(4):R268-80.

· Dahaba AA, et al. Remifentanil versus morphine analgesia and sedation for mechanically ventilated critically ill patients: a randomized double blind study. Anesthesiology. 2004 Sep;101(3):640-6.

· Bauer C, et al, Remifentanil-propofol versus fentanyl-midazolam combinations for intracranial surgery: influence of anaesthesia technique and intensive sedation on ventilation times and duration of stay in the ICU. Anaesthesist. 2007 Feb;56(2):128-32.

· Solteesz S, et al, Recovery after remifentanil and sufentanil for analgesia and sedation of mechanically ventilated patients after trauma or major surgery. Br J Anaesth. 2001 Jun？.86(6):7638.



■ 변경 전 고시번호(시행일자)

고시 제2014-242호(2015.1.1.)