The Effect of Desflurane with Remifentanil for Hemodynamic Responses to Skin Incision

Bae, Min Jeong; Lee, Guie Yong; Han, Jong In

Abstract

BACKGROUND: Desflurane can induce sympathetic nervous activity and increase mean arterial blood pressure and heart rate, especially when used above the concentration of MAC-BAR. Opioids can reduce this response during general anesthesia. We compared the effect of the use of 1 ng/ml remifentanil and 50% N2O with 1 MAC desflurane for cardiovascular responses to skin incision with the effects of the use of sevoflurane.
METHODS
We recruited 47 patients with ages between 20 and 60 years, and ASA physical status 1, who were scheduled for appendectomy surgery under general anesthesia. The patients were divided into two groups. Anesthesia was induced with remifentanil (target-controlled effect-site concentration of 2 ng/ml), 2 mg/kg propofol and 0.7 mg/kg rocuronium. After tracheal intubation, anesthesia was maintained as follows. Group D (desflurane) was administered an end-tidal concentration of 4.0% desflurane with remifentanil (target-controlled effect-site concentration of 1 ng/ml) and 50% N2O. Group S (sevoflurane) was administered an endtidal concentration of 1.1% sevoflurane with remifentanil (targetcontrolled effect-site concentration of 1 ng/ml) and 50% N2O. The mean arterial blood pressure and heart rate were measured at baseline, after tracheal intubation, every minute for 3 minutes before skin incision, and for 5 minutes after skin incision.
RESULTS
There was no difference in the changes of mean arterial blood pressure and heart rate between the patients in the two groups before and after skin incision.
CONCLUSIONS
As with sevoflurane, the addition of 1 ng/ml remifentanil to 1 MAC desflurane and 50% N2O can effectively blunt the cardiovascular responses to skin incision.