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

Kim, Kyoung Ok; Chung, Sung-Soo; Chang, Eunjung; Lee, Youn Suk

doi:10.4097/kjae.2011.60.1.8

Cited by 3 publications

(5 citation statements)

References 15 publications

(15 reference statements)

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“…Firstly, we used the bolus injection instead of target-controlled infusion since we focused on the pain of the rocuronium injection and accordingly modulated the administration method to be equivalent with other drugs. Secondly, time interval between remifentanil injection and endotracheal intubation was shorter in our study than previous study (about 120 vs. 250 second) [ 20 ]. It is well known that lidocaine was also effective for blunting the hemodynamic response to endotracheal intubation.…”

Section: Discussioncontrasting

confidence: 62%

“…Furthermore, remifentanil is frequently used for blunting hemodynamic changes during endotracheal intubation [ 19 , 20 ]. In this study, mean blood pressure and heart rate were significantly lower in the group which had remifentanil 1 µg/kg compared to other groups.…”

Section: Discussionmentioning

confidence: 99%

“…The preventive effect of remifentanil on hemodynamic changes during endotracheal intubation is dose dependent. Optimal effect-site concentration of remifentanil for preventing development of hypertension during endotracheal intubation is 3.3 ng/ml [ 20 ]. However, calculated effect-site concentration of remifentanil in the current study was 2.21-2.29 ng/ml according to the Minto kinetic model when it was assumed that intubation was done about 2 minutes after remifentanil 1 µg/kg administration [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

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Effects of lidocaine, ketamine, and remifentanil on withdrawal response of rocuronium

Jung

Kim

Bae

et al. 2014

Korean J Anesthesiol

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BackgroundRocuronium has been well known to produce withdrawal response in 50-80% patients when administered intravenously. Several drugs are administered prior injection of rocuronium to prevent the withdrawal response. We compared the preventive effect of lidocaine, ketamine, and remifentanil on the withdrawal response of rocuronium.MethodsA total of 120 patients undergoing various elective surgeries were enrolled. Patients were allocated into 4 groups according to the pretreatment drugs (Group N, normal saline; Groups L, lidocaine 40 mg; Group K, ketamine 0.5 mg/kg; Group R, remifentanil 1 µg/kg). Patients received drugs prepared by dilution to 3 ml volume before injection of rocuronium. Withdrawal responses after injection of rocuronium were graded on a 4-point scale. Hemodynamic changes were observed before and after administration of pretreatment drugs and after endotracheal intubation.ResultsIncidence of withdrawal response was significantly lower in group L (20%), group K (30%), and group R (0%), than group N (87%). Severe withdrawal response was observed in 5 of the 30 patients (17%) in group L, and in 9 of the 30 patients (30%) in group K. There was no severe withdrawal response in group R. Mean blood pressure and heart rate were significantly decreased in group R compared to other groups.ConclusionsIt seems that remifentanil (1 µg/kg intravenously) was the strongest and most effective in prevention of withdrawal response after rocuronium injection among the 3 drugs.

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Section: Discussioncontrasting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of lidocaine, ketamine, and remifentanil on withdrawal response of rocuronium

Jung

Kim

Bae

et al. 2014

Korean J Anesthesiol

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“…One such opioid is remifentanil; it effectively reduces hemodynamic changes during endotracheal intubation [ 16 29 30 31 ]. This short-acting opioid has a rapid onset and a blood-brain equilibrium half-time of 1 to 2 minutes [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Optimal effect-site concentration of remifentanil for minimizing cardiovascular changes caused by fiberoptic nasotracheal intubation

Kim

Jeon

Kim

et al. 2015

J Dent Anesth Pain Med

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BackgroundEndotracheal intubation induces clinically adverse cardiovascular changes. Various pharmacological strategies for controlling these responses have been suggested with opioids being widely administered. In this study, the optimal effect-site concentration (Ce) of remifentanil for minimizing hemodynamic responses to fiberoptic nasotracheal intubation was evaluated.MethodsThirty patients, aged 18-63 years, scheduled for elective surgery were included. Anesthesia was induced with a propofol and remifentanil infusion via target-controlled infusion (TCI). Remifentanil infusion was initiated at 3.0 ng/mL, and the response of each patient determined the Ce of remifentanil for the next patient by the Dixon up-and-down method at an interval of 0.5 ng/mL. Rocuronium was administered after propofol and remifentanil reached their preset Ce; 90 seconds later fiberoptic nasotracheal intubation was initiated. Non-invasive blood pressure and heart rate (HR) were measured at pre-induction, the time Ce was reached, immediately before and after intubation, and at 1 and 3 minutes after intubation. The up-and-down criteria comprised a 20% change in mean blood pressure and HR between just prior to intubation and 1 minute after intubation.ResultsThe median effective effect-site concentration (EC50) of remifentanil was 3.11 ± 0.38 ng/mL by the Dixon's up-and-down method. From the probit analysis, the EC50 of remifentanil was 3.43 ng/mL (95% confidence interval, 2.90-4.06 ng/mL). In PAVA, the EC50 and EC95 of remifentanil were 3.57 ng/mL (95% CI, 2.95-3.89) and 4.35 ng/mL (95% CI, 3.93-4.45). No remifentanil-related complications were observed.ConclusionsThe EC50 of remifentanil for minimizing the cardiovascular changes and side effects associated with fiberoptic nasotracheal intubation was 3.11-3.43 ng/mL during propofol TCI anesthesia with a Ce of 4 ug/mL.

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“…The effect-site remifentanil concentration of 3.3 ng/ml is useful for blunting hemodynamic responses in 95% of patients when 2.0 mg/kg of propofol induction is followed by 3% desflurane inhalation [12]. The effect-site remifentanil concentration of 4 ng/ml was required to alleviate the response by 5 min exposure of 1.7 MAC of desflurane inhalation [13].…”

Section: Discussionmentioning

confidence: 99%

Optimal dose of remifentanil for the prevention of hemodynamic responses during induction of anesthesia with desflurane

Hj¹,

Park²,

Baek³

et al. 2015

Anesth Pain Med

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

Cited by 3 publications

References 15 publications

Effects of lidocaine, ketamine, and remifentanil on withdrawal response of rocuronium

Effects of lidocaine, ketamine, and remifentanil on withdrawal response of rocuronium

Optimal effect-site concentration of remifentanil for minimizing cardiovascular changes caused by fiberoptic nasotracheal intubation

Optimal dose of remifentanil for the prevention of hemodynamic responses during induction of anesthesia with desflurane

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