Remifentanil in Combination with Propofol for Spontaneous Ventilation Anaesthesia

Peacock, J. E.; Luntley, Jeremy; O’Connor, Brian; Reilly, CS; Ogg, T. W.; Watson, B.; Shaikh, Soraya

doi:10.1097/00132586-199902000-00013

Cited by 25 publications

(32 citation statements)

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“…Propofol is known to be associated with intra-operative movements which, with manual infusion schemes, require additional boluses of propofol [1,3]. The incidence of movement in this study (55%) was comparable with previously published values [14,15], and was not particularly different from the 66% incidence observed in a previous investigation at this institution involving a manual infusion [3]. The severity of movements was less in the current investigation, however, and movements were rapidly terminated by selecting a higher propofol target.…”

supporting

confidence: 87%

Target‐controlled propofol vs. sevoflurane: a double‐blind, randomised comparison in day‐case anaesthesia

Smith

Thwaites

1999

Anaesthesia

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SummaryWe compared target-controlled propofol with sevoflurane in a randomised, double-blind study in 61 day-case patients. Anaesthesia was induced with a propofol target of 8 mg.ml ¹1 or 8% sevoflurane, reduced to 4 mg.ml ¹1 and 3%, respectively, after laryngeal mask insertion and subsequently titrated to clinical signs. Mean (SD) times to unconsciousness and laryngeal mask insertion were significantly shorter with propofol [50 (9) s and 116 (33) s, respectively] than with sevoflurane [73 (14) s and 146 (29) s; p < 0.0001 and p ¼ 0.0003, respectively]; however, these differences were not apparent to the blinded observer. Propofol was associated with a higher incidence of intra-operative movement (55 vs. 10%; p ¼ 0.0003), necessitating more adjustments to the delivered anaesthetic. Emergence was faster after sevoflurane [5.3 (2.2) min vs. 7.1 (3.7) min; p ¼ 0.027], but the inhaled anaesthetic was associated with more nausea and vomiting (30 vs. 3%; p ¼ 0.006), which delayed discharge [258 (102) min vs. 193 (68) min; p ¼ 0.005]. Direct costs were lower with sevoflurane but nausea would have increased indirect costs. Patient satisfaction was high (Ն 90%) with both techniques. In conclusion, both techniques had advantages and disadvantages for day-case anaesthesia.

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supporting

confidence: 87%

Target‐controlled propofol vs. sevoflurane: a double‐blind, randomised comparison in day‐case anaesthesia

Smith

Thwaites

1999

Anaesthesia

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“…Dose-dependent respiratory depression has been reported previously in day-case patients anaesthetised with intravenous remifentanil infusions in combination with either isoflurane 1.2% [2] or propofol [3]. In the former study, respiratory depression occurred in Ն 50% of patients at a remifentanil infusion rate of 0.05 mg.kg ¹1 .min ¹1 and in > 25% at 0.025 mg.kg ¹1 .min ¹1 with increased incidence of somatic response.…”

Section: Discussionmentioning

confidence: 65%

“…In the former study, respiratory depression occurred in Ն 50% of patients at a remifentanil infusion rate of 0.05 mg.kg ¹1 .min ¹1 and in > 25% at 0.025 mg.kg ¹1 .min ¹1 with increased incidence of somatic response. In the latter study, Peacock and colleagues [3] varied both the remifentanil and propofol infusion rates and reported adequate spontaneous respiration in 88% of study subjects by the end of surgery at a mean maintenance infusion rate for the remifentanil of 0.026-0.053 mg.kg ¹1 .min ¹1 . However, they also recorded a relatively high incidence of response to skin incision of 29-88%.…”

Section: Discussionmentioning

confidence: 97%

“…This pharmacological profile would make the drug appropriate as part of a total intravenous anaesthesia technique for day-case surgery. However, the drug's potency of action also applies to its respiratory depressant effects, which are dose dependent [2,3]. A target-controlled system, in which the calculated plasma concentration of remifentanil can be manipulated rapidly, provides an ideal opportunity to study the effects of varying the dose of the drug on the patient's respiration.…”

mentioning

confidence: 99%

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Target‐controlled remifentanil in combination with propofol for spontaneously breathing day‐case patients

1999

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SummaryRemifentanil is a new potent opioid with a very short duration of action irrespective of duration of infusion. It may have a role in day-case anaesthesia as part of a balanced total intravenous anaesthetic technique with propofol. We examined the respiratory depressant effects of remifentanil in 20 patients undergoing day-case anaesthesia. The target plasma concentration of remifentanil was varied while maintaining a constant target-controlled infusion of 4.5 mg.ml ¹1 propofol. In only 12 patients was satisfactory spontaneous respiration maintained. In these patients the median remifentanil target concentration was 1.6 ng.ml ¹1 and was achieved with a median infusion rate of 0.05 mg.kg ¹1 .min ¹1 . The range of target concentrations associated with satisfactory spontaneous respiration was wide and varied over a 4.7-fold range from 0.6 to 2.8 ng.ml ¹1 .

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“…The objective of the technique was to provide the patient with sedation and analgesia for the painful parts of the procedure, while allowing rapid arousal for speech testing. The use of manually controlled infusions of propofol and remifentanil in spontaneously breathing patients has already been described [2,9]. However, the use of target-controlled administration of hypnotics and opioids in this setting has been little reported.…”

Section: Discussionmentioning

confidence: 99%

Target‐controlled infusion of propofol and remifentanil combined with bispectral index monitoring for awake craniotomy

Hans¹,

Bonhomme²,

Born³

et al. 2000

Anaesthesia

101

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SummaryWe describe the target-controlled administration of propofol and remifentanil, combined with monitoring of the bispectral index, during an awake craniotomy for removal of a left temporoparietal tumour near the motor speech centre. Target concentrations of the two drugs were adjusted according to the patient's responses to painful stimuli and surgical events, and the need for speech testing. Allowing the effect-site concentrations of propofol and remifentanil to decrease during surgery allowed the performance of cortical speech mapping and the testing of the patient's ability to speak. Although the bispectral index was not used as a guide for the administration of the drugs, its value correlated better with the patient's responsiveness than did the predicted effect-site concentrations of propofol. Side-effects, comprising hypotension, respiratory depression and airway obstruction, were related to rapid increases in drug infusion rates and were easily managed.

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Remifentanil in Combination with Propofol for Spontaneous Ventilation Anaesthesia

Cited by 25 publications

References 0 publications

Target‐controlled propofol vs. sevoflurane: a double‐blind, randomised comparison in day‐case anaesthesia

Target‐controlled propofol vs. sevoflurane: a double‐blind, randomised comparison in day‐case anaesthesia

Target‐controlled remifentanil in combination with propofol for spontaneously breathing day‐case patients

Target‐controlled infusion of propofol and remifentanil combined with bispectral index monitoring for awake craniotomy

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