Korean J Anesthesiol.  2007 Nov;53(5):565-570. 10.4097/kjae.2007.53.5.565.

Changes of Hemodynamics and Bispectral Index by Tracheal Intubation according to Effect-site Concentration of Remifentanil during Propofol Anesthesia

• Lee HS
• Song JH
• Shinn HK
• Han JU
• Jung JK
• Yang CW
• Cho BK

• KMID: 1937367
• DOI: http://doi.org/10.4097/kjae.2007.53.5.565

Abstract

BACKGROUND: Combination of propofol and remifentanil is an ideal regimen for total intravenous anesthesia, and the bispectral index (BIS) has been used as an indicator of the sedative state during anesthesia. This study examined the effect of remifentanil on the mean arterial pressure (MAP), heart rate (HR) and BIS to laryngoscopy and tracheal intubation with 4microgram/ml of fixed target effect-site concentration infusion of propofol.
METHODS
In this double-blind study, fifty-one ASA physical status I-II patients, aged 20-60 yr undergoing elective surgery were randomly assigned to one of four groups according to the target effect-site concentration of remifentanil (0, 2, 3, 4 ng/ml). The target-controlled infusion (TCI) of remifentanil was initiated after the effect-site concentration of propofol was maintained with 4microgram/ml. After target effect-site concentration of remifentanil was reached, a neuromuscular blockade was produced by rocuronium 1 mg/kg and tracheal intubation was performed after 90 seconds. MAP, HR and BIS were measured at pre-induction, after reaching target effect-site concentration of propofol and remifentanil, before and after tracheal intubation.
RESULTS
The changes of MAP, HR and BIS after tracheal intubation were negatively correlated with remifentanil effect-site concentration.
CONCLUSIONS
Remifentanil attenuated the hemodynamic responses due to tracheal intubation and decreased BIS after tracheal intubation in a comparable dose-dependent fashion.

Keyword

BIS; propofol; remifentanil; target-controlled infusion; tracheal intubation

MeSH Terms

Anesthesia*
Anesthesia, Intravenous
Arterial Pressure
Double-Blind Method
Heart Rate
Hemodynamics*
Humans
Intubation*
Laryngoscopy
Neuromuscular Blockade
Propofol*
Propofol