Yonsei Med J.  2013 May;54(3):739-746. 10.3349/ymj.2013.54.3.739.

Effect-Site Concentration of Remifentanil for Minimizing Cardiovascular Changes by Inhalation of Desflurane

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Armed Forces Capital Hospital, Seongnam, Korea.
  • 2Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea. baikhj@ewha.ac.kr
  • 3Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.

Abstract

PURPOSE
This study aims to investigate the most appropriate effect-site concentration of remifentanil to minimize cardiovascular changes during inhalation of high concentration desflurane.
MATERIALS AND METHODS
Sixty-nine American Society of Anesthesiologists physical status class I patients aged 20-65 years were randomly allocated into one of three groups. Anesthesia was induced with etomidate and rocuronium. Remifentanil was infused at effect-site concentrations of 2, 4 and 6 ng/mL in groups R2, R4 and R6, respectively. After target concentrations of remifentanil were reached, desflurane was inhaled to maintain the end-tidal concentration of 1.7 minimum alveolar concentrations for 5 minutes (over-pressure paradigm). The systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) and end-tidal concentration of desflurane were measured for 5 minutes.
RESULTS
The end-tidal concentration of desflurane increased similarly in all groups. The SBP, DBP, MAP and HR within group R4 were not significantly different as compared with baseline values. However, measured parameters within group R2 increased significantly 1-3 minutes after desflurane inhalation. The MAP within group R6 decreased significantly at 1, 2, 4, and 5 minutes (p<0.05). There were significant differences in SBP, DBP, MAP and HR among the three groups 1-3 minutes after inhalation (p<0.05). The incidence of side effects such as hyper- or hypo-tension, and tachy- or brady-cardia in group R4 was 4.8% compared with 21.8% in group R2 and 15.0% in group R6.
CONCLUSION
The most appropriate effect-site concentration of remifentanil for blunting hemodynamic responses by inhalation of high concentration desflurane is 4 ng/mL.

Keyword

Remifentanil; desflurane; hemodynamic change

MeSH Terms

Adult
Aged
Androstanols/adverse effects/pharmacology
Anesthetics/adverse effects/pharmacology
Anesthetics, Inhalation/adverse effects/*pharmacology
Blood Pressure/drug effects
Etomidate/adverse effects/pharmacology
Female
Heart/*drug effects
Heart Rate/drug effects
Humans
Isoflurane/adverse effects/*analogs & derivatives/pharmacology
Male
Middle Aged
Piperidines/adverse effects/*therapeutic use
Protective Agents/adverse effects/*therapeutic use
Androstanols
Anesthetics
Anesthetics, Inhalation
Piperidines
Protective Agents
Isoflurane
Etomidate

Figure

  • Fig. 1 CONSORT flow chart showing participant disposition. SBP, systolic blood pressure; MAP, mean arterial pressure; HR, heart rate; CONSORT, consolidated standards of reporting trials.

  • Fig. 2 Changes in MAC value during desflurane inhalation. There were no significant differences among the groups. MAC, minimum alveolar concentration.

  • Fig. 3 Changes in SBP during desflurane inhalation. *p<0.05 compared with baseline value within groups, †p<0.05 compared with R2 group, ‡p<0.05 compared with R4 group. SBP, systolic blood pressure.

  • Fig. 4 Changes in DBP during desflurane inhalation. *p<0.05 compared with baseline value within groups, †p<0.05 compared with R2 group. DBP, diastolic blood pressure.

  • Fig. 5 Changes in MAP during desflurane inhalation. *p<0.05 compared with baseline value within groups, †p<0.05 compared with R2 group, ‡p<0.05 compared with R4 group. MAP, mean arterial pressure.

  • Fig. 6 Changes in HR during desflurane inhalation. *p<0.05 compared with baseline value within groups, †p<0.05 compared with R2 group. HR, heart rate.


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