Effect of a remifentanil bolus dose on the cardiovascular response to emergence from anaesthesia and tracheal extubation

Abstract

We have examined the effect of remifentanil on the haemodynamic response to emergence from anaesthesia and tracheal extubation in 40 ASA I-II female patients undergoing diagnostic laparoscopy, in a randomized, double-blind study. All patients received a standard general anaesthetic comprising propofol, vecuronium and 1% isoflurane with 66% nitrous oxide in oxygen. At the end of surgery, a bolus dose of remifentanil 1 microgram kg-1 (n = 20) or saline placebo (n = 20) was given and tracheal extubation was performed when standard criteria were achieved. Arterial pressure and heart rate were recorded non-invasively at 1-min intervals from the end of surgery. Remifentanil attenuated the increase in both mean arterial pressure (P < 0.001) and heart rate (P < 0.05) at extubation. Mean time to extubation was 7.2 (SEM 0.6) min and 4.0 (0.5) min in the remifentanil and saline groups, respectively (P < 0.001). There was no difference in the incidence of coughing at extubation, time to recovery from anaesthesia or time to fitness for discharge from the recovery room.

Optimal dose of dexmedetomidine for attenuating cardiovascular response during emergence in patients undergoing total laparoscopic hysterectomy

“…3,4 Many studies have investigated strategies to attenuate hyperdynamic responses, including extubation under deep anaesthesia and the use of calcium-channel blockers, b-blockers or short-acting opioids. [5][6][7] However, although extubation during the deep planes of anaesthesia avoids cardiovascular stimulation, it can also depress the respiratory and circulatory systems and occasionally results in difficulty managing the upper airway; 5 drug treatments have not been fully successful. 6,7 Dexmedetomidine is a highly specific a2-agonist with sedative, analgesic and sympatholytic effects without significant respiratory depression.…”

Effects of maintaining intravenous infusion of remifentanil or propofol on anesthesia and palinesthesia during anesthesia and analepsia

“…In order to prevent a high dynamic response and choking in the recovery process of general anesthesia and extubation, many methods, such as deep anesthesia extubation, the use of local anesthetics, vasodilators, short-acting opioid drugs, and other methods, have been used in the clinic (Shajar et al, 1999;Hohlrieder et al, 2007). Studies have reported that the application of general anesthesia with propofol or remifentanil could make the recovery process of patients smoother (Shajar et al, 1999;Wilhelm et al, 2001;Blayney et al, 2003;Hohlrieder et al, 2007). However, propofol and remifentanil, which are more conducive to allowing patients to pass through the recovery period safely, have been less characterized.…”

“…It has been widely used in clinical anesthesia (Hughes et al, 1992;Kapila et al, 1995;Soltesz et al, 2001). Recent studies have shown that the use of remifentanil can benefit patients who are awake (Shajar et al, 1999;Wilhelm et al, 2001;Hohlrieder et al, 2007). The purpose of this study was to investigate the effect of maintaining an intravenous infusion of remifentanil or propofol on the performance of general anesthesia, including the cardiovascular response, choking, and irritability at the end of general anesthesia, in order to assess the effect of a maintenance intravenous infusion of remifentanil or propofol.…”

Extubation of the surgically resected airway — a role for remifentanil and propofol infusions

“…[17][18][19] Both of these drugs can suppress the cardiovascular response during emergence. 20,21 A continuous infusion of remifentanil between 0.05 to 0.075 µg·kg -1 ·min -1 has been demonstrated to provide good intubating conditions. 18,19 When remifentanil was used alone, a high incidence of recall was reported.…”