The optimal effect-site concentration of remifentanil for lightwand tracheal intubation during propofol induction without muscle relaxation

Han, Jeong Uk; Cho, Sangyun; Jeon, Woo Jae; Yeom, Jong Hoon; Shin, WooJong; Shim, Jae Hang; Kim, Kyoung Hun

doi:10.1016/j.jclinane.2010.12.012

Cited by 10 publications

(10 citation statements)

References 24 publications

(27 reference statements)

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“…Non-invasive blood pressure, SpO 2 , ECG were monitored and recorded every minute. Anaesthesia was induced with propofol target control infusion (4μg.ml −1 ) and remifentanil (3.5ng.ml −1 ) followed by succinylcholine (1mg.kg −1 ) [ 8 ]. After anesthesia induction, direct laryngoscopy was performed with a Macintosh size 3 blade, the trachea was intubated by one of four anesthesiologists, who was experienced with jet ventilation and had completed at least 50 successful tracheal intubations using lightwand before the study.…”

Section: Methodsmentioning

confidence: 99%

“…Jet ventilation was performed using a manual jet ventilator (Manujet III, VBM Medizintechnik GmbH, Germany) was connected to the proximal end of jet catheter. The operator adjusted the distal tip of the lightwand until the midline illumination was observed in the anterior neck, the maximum stable PetCO 2 and chest rise were achieved [ 7 – 8 ]. The WEI JET was then slid into the trachea over the lightwand and the PetCO 2 monitoring catheter.…”

Section: Methodsmentioning

confidence: 99%

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Laryngoscope and a New Tracheal Tube Assist Lightwand Intubation in Difficult Airways due to Unstable Cervical Spine

Wei

et al. 2015

PLoS ONE

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PurposeThe WEI Jet Endotracheal Tube (WEI JET) is a new tracheal tube that facilitates both oxygenation and ventilation during the process of intubation and assists tracheal intubation in patients with difficult airway. We evaluated the effectiveness and usefulness of the WEI JET in combination with lightwand under direct laryngoscopy in difficult tracheal intubation due to unstable cervical spine.MethodsNinety patients with unstable cervical spine disorders (ASA I-III) with general anaesthesia were included and randomly assigned to three groups, based on the device used for intubation: lightwand only, lightwand under direct laryngoscopy, lightwand with WEI JET under direct laryngoscopy.ResultsNo statistically significant differences were detected among three groups with respect to demographic characteristics and C/L grade. There were statistically significant differences between three groups for overall intubation success rate (p = 0.015) and first attempt success rate (p = 0.000). The intubation time was significantly longer in the WEI group (110.8±18.3 s) than in the LW group (63.3±27.5 s, p = 0.000) and DL group (66.7±29.4 s, p = 0.000), but the lowest SpO2 in WEI group was significantly higher than other two groups (p<0.01). The WEI JET significantly reduced successful tracheal intubation attempts compared to the LW group (p = 0.043). The severity of sore throat was similar in three groups (p = 0.185).ConclusionsThe combined use of WEI JET under direct laryngoscopy helps to assist tracheal intubation and improves oxygenation during intubation in patients with difficult airway secondary to unstable spine disorders.Trial RegistrationChinese Clinical Trial Registry ChiCTR-TRC-14005141

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Laryngoscope and a New Tracheal Tube Assist Lightwand Intubation in Difficult Airways due to Unstable Cervical Spine

Wei

et al. 2015

PLoS ONE

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“…The sample size of the effective concentration titrated by the improved sequential method is not clearly de ned. A sample size of 20-40 has been used in general studies [12]. In the present study, the sample size of the effective concentration titrated by remifentanil was 30.…”

Section: Discussionmentioning

confidence: 98%

“…Continuous variables were compared using the Mann-Whitney U test or T-test. EC95, EC50, the standard error and the logarithm value of the 95% con dence interval (CI) of remifentanil were calculated by the formula of the sequential method [12]. The sample size of the effective concentration titrated by the improved sequential method is not clearly de ned.…”

Section: Discussionmentioning

confidence: 99%

Inhibition of Stress and Spontaneous Respiration: Efficacy and Safety of Monitored Anaesthesia Care by Remifentanil in Fibreoptic Bronchoscopy for Patients with Severe Tracheal Stenosis

Zhou

Zhu

et al. 2021

Preprint

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Objective To determine the effective concentration of target-controlled infusion (TCI) of remifentanil used to inhibit stress during the treatment of severe tracheal stenosis with fibreoptic bronchoscopy and to evaluate the safety of the monitored anaesthesia care (MAC) by remifentanil.Methods A study of 60 patients with severe tracheal stenosis who underwent diagnostic and therapeutic fibreoptic bronchoscopy at Shanghai Pulmonary Hospital affiliated with Tongji University was performed. Dexmedetomidine was initially administered at a bolus dose (0.8 mcg/kg), followed by a 0.5 mcg/(kg·h) continuous infusion. Remifentanil was administered by TCI. When the target concentration was reached, the nasopharyngeal airway was inserted, and then oxygen was supplied by a connected anaesthesia machine. The effective concentration of remifentanil was titrated by the improved sequential method, and 30 patients were included. The EC95 of remifentanil was set as the plasma target concentration to evaluate the safety of the MAC, and another 30 patients were included. Remedy measures: Propofol (10-20 mg) was injected intravenously. The primary outcome measures were the cough score and the incidence and severity of hypoxemia. The tolerance score for nasopharyngeal airway placement, Ramsay sedation score, haemodynamic changes, satisfaction score, patients’ 24 h recall score, patients’ willingness to re-receive the procedure, and related adverse events were recorded.Results On the basis of sedation with dexmedetomidine, the EC95 of remifentanil for inhibiting the stress response in fibreoptic bronchoscopy performed on patients with severe tracheal stenosis was 2.710 ng/ml (95% CI, 2.471-4.473 ng/ml), and the EC50 was 2.243 ng/ml (95% CI, 2.061-2.446 ng/ml). Among the 30 patients who received an EC95 of remifentanil as the target concentration, 1 patient was remedied by injecting propofol; the tolerance score for insertion of the nasopharyngeal airway was 2, the score of Ramsay sedation was 3, and the cough score was 1. The incidence of respiratory depression was 50%, the incidence of hypoxemia was 20%, and 86.7% of patients with respiratory depression returned to normal by awakening. One patient returned to normal by mask-assisted ventilation, and another returned to normal by laryngeal mask mechanical ventilation. The satisfaction score of the operator was 9, the satisfaction score of the anaesthesiologist was 8, the satisfaction score of the patients was 10, the score of the patients' 24 h operative recall was 1, the rate of patient willingness to re-accept the procedure was 93.3%, the incidence of throat pain at 30 min after the end of the operation was 16.7%, and the circulation was stable during the operation. No pruritus, nausea, vomiting or other related adverse reactions were reported.Conclusion MAC using TCI of remifentanil can effectively inhibit the stress response to fibreoptic bronchoscopy in patients with severe tracheal stenosis while maintaining spontaneous breathing. The patients are safe and comfortable and express high satisfaction, making this method worthy of clinical application.Trial registration Registration date : 12/02/2021, Registration number: ChiCTR2100043380.

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“…Podawanie propofolu za pomocą TCI zapewnia szybkie wprowadzenie do znieczulenia i utrzymanie jego stabilnego poziomu [4,5]. Istnieją jednak osobnicze różnice w farmakokinetyce propofolu, dlatego należy indywidualnie dobierać dawkę leku dla każdego chorego, zarówno do indukcji jak i podtrzymania znieczulenia [6,7].…”

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Wpływ monitorowania indeksu bispektralnego na dawkowanie środków anestetycznych w docelowej infuzji kontrolowanej do operacji dysków lędźwiowych

Karwacki

Niewiadomski²,

Rzaska³

et al. 2014

Anaesthesiol Intensive Ther

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Należy cytować anglojęzyczną wersję artykułu z: Karwacki Z, Niewiadomski S, Rzaska M, Witkowska M: The effect of bispectral index monitoring on anaesthetic requirements in target--controlled infusion for lumbar microdiscectomy. Anaesthesiol Intensive Ther 2014; 46: 284-288 Wpływ monitorowania indeksu bispektralnego na dawkowanie środków anestetycznych w docelowej infuzji kontrolowanej do operacji dysków lędźwiowychThe effect of bispectral index monitoring on anaesthetic requirements in target-controlled infusion for lumbar microdiscectomy Zbigniew Karwacki, Seweryn Niewiadomski, Marta Rzaska, Małgorzata Witkowska Zakład Neuroanestezjologii Gdańskiego Uniwersytetu Medycznego AbstractBackground: Target-controlled infusion (TCI) is used to maintain the desired concentration of a hypnotic drug in the plasma and brain. However, pharmacodynamic variability can cause problems with maintaining the adequate level of anaesthesia. The bispectral index (BIS) is one of only a few parameters that allow an assessment of the depth of anaesthesia. In the present study, we attempted to determine the optimal dosages of drugs used for total intravenous anaesthesia with TCI based on BIS-guided monitoring of depth of anaesthesia. Methods:The study was conducted in 60 ASA I patients undergoing elective surgery due to lumbar discopathy. The participants were divided into two groups of 30 individuals. The patients were premedicated with 15 mg oral midazolam. Group I was the control group; group II received BIS monitoring. Anaesthesia was induced with TCI propofol (4 mg mL -1 ), fentanyl (2 mg kg -1 ) and vecuronium (0.12 mg kg -1 ) and maintained with TCI propofol, continuous infusion of vecuronium (0.03 mg kg -1 h -1 ) and fractionated doses of fentanyl. ECG, HR, MAP, SaO 2 , ETCO 2, and the degree of neuromuscular blockade were monitored, specifically at the following time points: T 1 -before induction, T 2 -after induction, T 3 -after intubation, T 4 -after positioning of the patient, T 5 -T 13 -every 5 min during surgery, T 14 -on completion of surgery, T 15 -before extubation, T 16 -after extubation. Results:The study groups were comparable in terms of age, body weight, duration of anaesthesia and recovery time.The haemodynamic parameters, such as HR and MAP, did not differ significantly between the groups. In both groups, changes in the mean MAP values were observed between T 1 and T 2 , T 2 and T 3 , T 3 and T 4 as well as T 14 and T 15 . The total dose of fentanyl and the doses of propofol were lower in the group that received BIS monitoring. Conclusion: BIS monitoring reduces the doses of opioids and hypnotics used during total intravenous anaesthesia by TCI.

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The optimal effect-site concentration of remifentanil for lightwand tracheal intubation during propofol induction without muscle relaxation

Cited by 10 publications

References 24 publications

Laryngoscope and a New Tracheal Tube Assist Lightwand Intubation in Difficult Airways due to Unstable Cervical Spine

Laryngoscope and a New Tracheal Tube Assist Lightwand Intubation in Difficult Airways due to Unstable Cervical Spine

Inhibition of Stress and Spontaneous Respiration: Efficacy and Safety of Monitored Anaesthesia Care by Remifentanil in Fibreoptic Bronchoscopy for Patients with Severe Tracheal Stenosis

Wpływ monitorowania indeksu bispektralnego na dawkowanie środków anestetycznych w docelowej infuzji kontrolowanej do operacji dysków lędźwiowych

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