The target concentration of remifentanil to suppress the hemodynamic response to endotracheal intubation during inhalational induction with desflurane

Abstract

BackgroundAnesthesia induction with desflurane is troublesome because of the frequent sympathetic hyperactivity during desflurane administration. We thought that a low concentration of desflurane combined with a target-controlled infusion (TCI) of remifentanil would eliminate the desflurane-related complications and provide hemodynamic stability during desflurane induction. An up-and-down study was planned to find the target effect-site concentration of remifentanil to block the hemodynamic response to endotracheal intubation, the highest level of stimulus, during anesthesia induction with administering desflurane at 1 MAC.MethodsRemifentanil TCI was initiated before desflurane administration. When the preset target was achieved, spontaneous inhalation of desflurane 1 MAC was performed until the patients became unconscious. Laryngoscopic tracheal intubation was facilitated with rocuronium injection. The starting concentration of remifentanil and the test space were 5 and 1 ng/ml, respectively. The criteria for up-and-down was a 20% increase of the mean arterial pressure or heart rate after intubation. The median effective concentration (EC50) of remifentanil was calculated from 6 independent pairs. The complications related with remifentanil and desflurane were assessed during the study.ResultsWe studied 20 patients using 2-5 ng/ml of the effect-site concentrations of remifentanil. The EC50 of remifentanil was 3.7 ng/ml. Loss of consciousness was achieved at 125 ± 22 s after desflurane inhalation and this was irrespective of the combined remifentanil concentrations. Any remifentanil-related complication was not observed. Transient cough was seen in one patient who received 2 ng/ml of remifentanil.ConclusionsWe demonstrated that uncomplicated induction with desflurane was possible by the use of target-controlled remifentanil. The EC50 of remifentanil to block the hemodynamic response to tracheal intubation was 3.7 ng/ml during inhalational induction with 1 MAC desflurane.

Preoperative Low-dose and High-dose Pregabalin and Cardiovascular Response to Endotracheal Intubation: A Prospective, Randomized, Single-blind, Controlled Study in China

“…There were no significant differences in applications of fentanyl (71. 4 between the control, LDP, and HDP groups, respectively. In contrast, the mean visual analog scale scores at 1 hour after the end of surgery were significantly lower after limb and spinal surgery in the HDP group compared to that in the LDP group, as well as after abdominal surgery in the LDP group ( Figure 1B) At 1 hour after premedication, the mean heart rate in the HDP group was significantly lower than those in the control and LDP groups (both, P < 0.05).…”

“…1 Although bronchospasm, intracranial and intraocular pressure elevation, hypertension, tachycardia, arrhythmia, and especially hemodynamic alterations occur transiently, the responses can be deleterious to patients with diseases of the cardio-/cerebrovascular and endocrine systems. 2,3 Various therapeutic medications and methods have been employed to reduce or suppress cardiovascular responses caused by endotracheal intubation, 4 including local anesthesia, 5 intravenous lidocaine, 6 drugs affecting adrenergic receptors (eg, b-adrenoceptor antagonists, 7 a 1 -and a 2 -adrenocepter agonists 8 ), vasoactive agents (eg, glyceryl trinitrate, 9 calcium channel blockers, 10 sodium nitroprusside 11 ), and a laryngeal mask. 12 However, the optimal medicine or method to avoid stress responses in these patients has not been unequivocally established.…”

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

“…Remifentanil is one of the most widely used drugs for ng/ml in adults [3] and 3.4 ng/ml in children [11]. 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].…”

“…It is especially dangerous to patients with cardiovascular or cerebrovascular disease. Cardiovascular stimulation produced by desflurane can be attenuated by using opioids, β-blockers, and α 2-agonists [2][3][4][5]. However, the drug with a long duration of action may cause hypotension during the period without stimulation after endotracheal intubation.…”

Effect-site concentration of remifentanil for smooth inhalational induction with desflurane

“… 4 – 7 Preadministration of an opioid before desflurane has been reported to be able to make the transition from being awake to loss of consciousness (LOC) smooth and feasible without causing airway irritation. 4 , 5 , 8 , 9 Remifentanil is an ultrashort-acting opioid; the onset time is very rapid and the context sensitive half-life is 3–5 min. 10 , 11 Therefore, it is easy to titrate and adjust remifentanil to obtain its optimal dose without the concern of delayed recovery.…”