Korean J Anesthesiol.  2008 Jan;54(1):30-36. 10.4097/kjae.2008.54.1.30.

What is the Optimal Effect-site Concentration of Remifentanil for Minimizing the Cardiovascular Changes to Endotracheal Intubation during Induction with Propofol?

• Kim SK
• Kim DK
• Son JS
• Ko SH
• Lee JR

• KMID: 2236568
• DOI: http://doi.org/10.4097/kjae.2008.54.1.30

Abstract

BACKGROUND: In this study, the optimal effect-site concentration of remifentanil for blunting hemodynamic responses to endotracheal intubation during total intravenous anesthesia using propofol were evaluated.
METHODS
137 ASA class I and II patients, aged 18-60 years, were randomly allocated to one of six groups according to the effect-site concentration of remifentanil. Remifentanil was then infused at a target effect-site concentration of 0, 1, 2, 3, 4 or 6 ng/ml in groups R0, R1, R2, R3, R4 and R6, respectively. Anesthesia was induced with propofol infusion at a target effect-site concentration of 4microgram/ml endotracheal intubation was performed 5 minutes after remifentanil administration. Blood pressure (BP), heart rate (HR) and cardiac index (CI) were recorded at the baseline and then every 30 seconds until 3 minutes after intubation.
RESULTS
BP and HR in groups R0, R1 and R2 increased significantly after intubation when compared with the baseline values. The CI in group R0 also increased significantly after intubation when compared with the baseline values. Incidences of hypertension and hypotension were 50% and 5% in R0, 32% and 14% in R1, 18% and 32% in R2, 10% and 48% in R3, 8% and 54% in R4, and 0% and 81% in R6. There were also 2 cases in which the mean blood pressure was less than 50 mmHg in group R6.
CONCLUSIONS
We suggest that the optimal target effect-site concentrations of remifentanil for blunting hemodynamic responses to endotracheal intubation are 3 or 4 ng/ml during total intravenous anesthesia using propofol at an effect-site concentration of 4microgram/ml.

Keyword

cardiovascular changes; effect-site concentration; intubation; propofol remifentanil

MeSH Terms

Aged
Anesthesia
Anesthesia, Intravenous
Blood Pressure
Heart Rate
Hemodynamics
Humans
Hypertension
Hypotension
Incidence
Intubation
Intubation, Intratracheal
Piperidines
Propofol
Piperidines
Propofol