Desflurane-mediated Neurocirculatory Activation in Humans

Muzi, Michael; Lopatka, Craig W.; Ebert, Thomas J.

doi:10.1097/00000542-199605000-00004

Cited by 36 publications

(4 citation statements)

References 7 publications

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“…These favorable pharmacokinetic characteristics are useful in ambulatory surgery because of the shorter post-anaesthetic recovery time. However, neurocirculatory activation with tachycardia and hypertension during rapid increase in the inspired desflurane concentration prevents its widespread use, particularly in the patients with hypertension or ischemic heart disease [11,12]. …”

Section: Discussionmentioning

confidence: 99%

Optimal effect-site concentration of remifentanil for preventing development of hypertension during tracheal intubation with inhaled desflurane induction

Kim

Chung

Chang

et al. 2011

Korean J Anesthesiol

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BackgroundThe aim of the present study was to determine the effect-site concentration of remifentanil needed to prevent haemodynamic instability during tracheal intubation with inhaled desflurane induction.MethodsOne hundred American Society of Anesthesiologists I and II female patients were randomized to receive an effect-site concentration of remifentanil of 0, 1, 2, 3, or 4 ng/ml. Induction of anaesthesia was started with intravenous injection of propofol 2 mg/kg. Ninety seconds after the completion of propofol injection, rocuronium (0.8 mg/kg) and remifentanil were administered simultaneously with 3% desflurane inhalation. Tracheal intubation was attempted 150 sec after the commencement of remifentanil administration.ResultsA probit model of remifentanil concentration was predictive of successful intubation without development of hypertension (P for goodness-of-fit = 0.419). The effect-site concentration of remifentanil needed to achieve successful intubation without development of hypertension in 95% of the patients was 3.3 ng/ml (95% confidence interval, 2.6-4.8 ng/ml).ConclusionsThe effect-site concentration of remifentanil of 3.3 ng/ml is effective in blunting the haemodynamic response in 95% of the patients when 2.0 mg/kg of propofol induction was followed by 3% desflurane inhalation.

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Section: Discussionmentioning

confidence: 99%

Optimal effect-site concentration of remifentanil for preventing development of hypertension during tracheal intubation with inhaled desflurane induction

Kim

Chung

Chang

et al. 2011

Korean J Anesthesiol

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“…Furthermore, more rapid control of intra‐operative blood pressure may be possible because of the low solubility of desflurane and sevoflurane [10–13]. Desflurane, the agent that may lead to the fastest return of consciousness [10, 14–19], may be associated with neurocirculatory excitation, resulting in tachycardia, systemic and pulmonary hypertension and myocardial ischaemia [14–19] when inspired concentrations are increased rapidly. Despite using β‐adrenergic blockers and opiates to blunt these responses associated with desflurane, a correlation between increased norepinephrine (noradrenaline) levels and unstable haemodynamics was observed in an elderly population scheduled for different types of surgery [20].…”

mentioning

confidence: 99%

Isoflurane, desflurane and sevoflurane for carotid endarterectomy

Umbrain¹,

Keeris²,

D’Haese³

et al. 2000

Anaesthesia

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SummaryAfter carotid endarterectomy under general anaesthesia, the rapid elimination of desflurane and sevoflurane may allow earlier postoperative neurological assessment than after the use of isoflurane. However, desflurane may be associated with tachycardia and hypertension and may therefore increase cardiovascular risk. We investigated haemodynamic and recovery characteristics in patients scheduled for carotid endarterectomy who were anaesthetised with isoflurane, sevoflurane or desflurane. No significant peri-operative differences were noted in cardiac index or ST segment analysis. The times to extubation, movement on command and consciousness were shorter after desflurane and sevoflurane than after isoflurane anaesthesia. Postoperative pain, nausea, vomiting and shivering were similar in the three study groups.

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“…The high pungency of desflurane mades volatile induction of anesthesia with desflurane unacceptable. However, these two complications were minimal or not evident when desflurane was administered at concentrations less than 1 MAC [13,14]. Thus, we postulated that the desflurane-related complications would be eliminated by using as low as 1 MAC of desflurane.…”

Section: Discussionmentioning

confidence: 99%

The target concentration of remifentanil to suppress the hemodynamic response to endotracheal intubation during inhalational induction with desflurane

Lee

Jung

2011

Korean J Anesthesiol

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BackgroundAnesthesia induction with desflurane is troublesome because of the frequent sympathetic hyperactivity during desflurane administration. We thought that a low concentration of desflurane combined with a target-controlled infusion (TCI) of remifentanil would eliminate the desflurane-related complications and provide hemodynamic stability during desflurane induction. An up-and-down study was planned to find the target effect-site concentration of remifentanil to block the hemodynamic response to endotracheal intubation, the highest level of stimulus, during anesthesia induction with administering desflurane at 1 MAC.MethodsRemifentanil TCI was initiated before desflurane administration. When the preset target was achieved, spontaneous inhalation of desflurane 1 MAC was performed until the patients became unconscious. Laryngoscopic tracheal intubation was facilitated with rocuronium injection. The starting concentration of remifentanil and the test space were 5 and 1 ng/ml, respectively. The criteria for up-and-down was a 20% increase of the mean arterial pressure or heart rate after intubation. The median effective concentration (EC50) of remifentanil was calculated from 6 independent pairs. The complications related with remifentanil and desflurane were assessed during the study.ResultsWe studied 20 patients using 2-5 ng/ml of the effect-site concentrations of remifentanil. The EC50 of remifentanil was 3.7 ng/ml. Loss of consciousness was achieved at 125 ± 22 s after desflurane inhalation and this was irrespective of the combined remifentanil concentrations. Any remifentanil-related complication was not observed. Transient cough was seen in one patient who received 2 ng/ml of remifentanil.ConclusionsWe demonstrated that uncomplicated induction with desflurane was possible by the use of target-controlled remifentanil. The EC50 of remifentanil to block the hemodynamic response to tracheal intubation was 3.7 ng/ml during inhalational induction with 1 MAC desflurane.

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Desflurane-mediated Neurocirculatory Activation in Humans

Cited by 36 publications

References 7 publications

Optimal effect-site concentration of remifentanil for preventing development of hypertension during tracheal intubation with inhaled desflurane induction

Optimal effect-site concentration of remifentanil for preventing development of hypertension during tracheal intubation with inhaled desflurane induction

Isoflurane, desflurane and sevoflurane for carotid endarterectomy

The target concentration of remifentanil to suppress the hemodynamic response to endotracheal intubation during inhalational induction with desflurane

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