Yonsei Med J.  2015 Jul;56(4):1128-1133. 10.3349/ymj.2015.56.4.1128.

Predicted EC50 and EC95 of Remifentanil for Smooth Removal of a Laryngeal Mask Airway Under Propofol Anesthesia

• Yoo JY
• Kwak HJ
• Lee KC
• Kim GW
• Kim JY

• KMID: 2366357
• DOI: http://doi.org/10.3349/ymj.2015.56.4.1128

Abstract

PURPOSE
The purpose of this study was to determine the effect-site concentration (Ce) of remifentanil in 50% of patients (EC50) and 95% of patients (EC95) for smooth laryngeal mask airway (LMA) removal in adults under propofol and remifentanil anesthesia.
MATERIALS AND METHODS
Twenty-five patients of ASA physical status I-II and ages 18-60 years who were to undergo minor gynecological or orthopedic surgery were assessed in this study. Anesthesia was induced and maintained with propofol and remifentanil target-controlled infusion (TCI). Remifentanil was maintained at a predetermined Ce during the emergence period. The modified Dixon's up-and-down method was used to determine the remifentanil concentration, starting from 1.0 ng/mL (step size of 0.2 ng/mL). Successful removal of the LMA was regarded as absence of coughing/gagging, clenched teeth, gross purposeful movements, breath holding, laryngospasm, or desaturation to SpO2<90%.
RESULTS
The mean+/-SD Ce of remifentanil for smooth LMA removal after propofol anesthesia was 0.83+/-0.16 ng/mL. Using isotonic regression with a bootstrapping approach, the estimated EC50 and EC95 of remifentanil Ce were 0.91 ng/mL [95% confidence interval (CI), 0.77-1.07 ng/mL] and 1.35 ng/mL (95% CI, 1.16-1.38 ng/mL), respectively.
CONCLUSION
Our results showed that remifentanil TCI at an established Ce is a reliable technique for achieving safe and smooth emergence without coughing, laryngospasm, or other airway reflexes.

Keyword

Laryngeal mask airway; effect-site concentration; general anesthesia; remifentanil; target-controlled infusion; device removal

MeSH Terms

Adolescent
Adult
Analgesics, Opioid/*administration & dosage
Anesthetics, Inhalation/*administration & dosage
Cough/prevention & control
Device Removal
Dose-Response Relationship, Drug
Female
Gynecologic Surgical Procedures
Humans
*Laryngeal Masks
Male
Middle Aged
Orthopedic Procedures
Piperidines/*administration & dosage
Propofol/*administration & dosage
Treatment Outcome
Young Adult
Analgesics, Opioid
Anesthetics, Inhalation
Piperidines
Propofol

Figure

• 

  Fig. 1 The responses of 25 patients to laryngeal mask airway removal and the remifentanil concentration. Arrows represent the midpoint doses of all independent pairs of patients involving a crossover (i.e., success to failure). The remifentanil concentration required for smooth removal in 50% of the patients was 0.83±0.16 ng/mL.

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