Korean J Anesthesiol.  2012 Jul;63(1):25-29. 10.4097/kjae.2012.63.1.25.

Effect of a target-controlled infusion of remifentanil in combination with desflurane during the "maintenance" phase of general anesthesia

• Shin MK
• Shim HS
• Yang GY
• Sung WS

• KMID: 2092335
• DOI: http://doi.org/10.4097/kjae.2012.63.1.25

Abstract

BACKGROUND
The goal of this study was to determine the optimal target-controlled concentration of remifentanil combined with desflurane, by using a more widely and decreasing end-tidal concentration of desflurane.
METHODS
Ninety ASA I patients, who underwent general anesthesia for elective orthopedic or extremity surgeries, were registered and randomly allocated to receive either a target-controlled concentration of 1 ng/ml (group R1), 2 ng/ml (group R2) remifentanil, or desflurane only without remifentanil infusion (group D). Mean arterial pressure (MAP) and heart rate (HR) were recorded at 5-min intervals from after a 10-15 min period of surgical incision to before a 10-min period prior to the end of an operation. End-tidal concentration of desflurane was increased or decreased in proportion to the changes in MAP and HR. If the value of bispectral index (BIS) was from 60-62 for more than 2 min or systolic blood pressure would fall below 90 mmHg, the patient was excluded from the study to prevent a risk of "explicit awareness" and shock.
RESULTS
The end-tidal desflurane concentration was lower in the group receiving 1 ng/ml (5.2 +/- 0.5 vol%; P < 0.001) and 2 ng/ml remifenanil (4.4 +/- 0.5 vol%; P < 0.001) compared to patients in group D (7.9 +/- 0.5 vol%).
CONCLUSIONS
We recommend the use of 2 ng/ml or less remifentanil combined with desflurane for decreasing concentrations of desflurane without significant side effects, during the "maintenance" phase, and not during the induction phase of general anesthesia.

Keyword

Desflurane; Remifentanil; Target-controlled infusion

MeSH Terms

Anesthesia, General
Arterial Pressure
Blood Pressure
Extremities
Heart Rate
Humans
Isoflurane
Orthopedics
Piperidines
Isoflurane
Piperidines