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

Abstract

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 .

Facilitation of laryngeal mask airway insertion Effects of remifentanil administered before induction with target‐controlled propofol infusion

“…Varying times of apnoea duration after various doses of remifentanil have been reported in different studies. This may be attributed to different infusion times and different patient characteristics; the response to opioids in the general public can vary immensely [10, 19]. Although our study illustrated a greater incidence of apnoea in the remifentanil group, this was not found to be statistically significant.…”

Remifentanil used to supplement propofol does not improve quality of sedation during spontaneous respiration

“…Two earlier studies focused on the interaction between propofol and remifentanil in terms of respiratory depression during spontaneous ventilation. 13,14 The authors concluded that using remifentanil in the spontaneously breathing patient requires close monitoring and supervision to ensure individual titration of analgesic versus respiratory depressant effects, which occurred in 40% of treated patients. This is in agreement with the results found in our study, in which adequate spontaneous respi- propofol group.…”

Skin conductance correlates with perioperative stress

“…Propofol was used for hypnotic effect and remifentanil for opioid analgesic effect. Anaesthesia was induced with remifentanil using a non‐commercial target control infusion system (TCI), developed by Kenny/Engbers research group (13) connected to a Graseby 3400 infusion pump. Remifentanil target was set to 5.0 ng/ml.…”