J Dent Anesth Pain Med.  2018 Oct;18(5):295-300. 10.17245/jdapm.2018.18.5.295.

Optimal effective-site concentration of remifentanil for sedation during plate removal of maxilla

• Park JH
• Yoon JY
• Kim EJ
• Yoon JU
• Choi BM
• Ahn JH

• KMID: 2424370
• DOI: http://doi.org/10.17245/jdapm.2018.18.5.295

Abstract

BACKGROUND
Removal of the plate following Le Fort I osteotomy and BSSO (bilateral sagittal split osteotomy) is a common procedure. However, patients who undergo plate removal experience intense pain and discomfort. This study investigated the half-maximal effective concentration (Ce50 ) of remifentanil in the prevention of plate removal pain under sedation using dexmedetomidine.
METHODS
The study evaluated 18 patients, between 18 and 35 years of age, scheduled for elective surgery. Remifentanil infusion was initiated after sedation using dexmedetomidine, and started at a dose of 1.5 ng/mL on the first patient via target-controlled infusion (TCI). Patients received a loading dose of 1.0 µg/kg dexmedetomidine over 10 min, followed by a maintenance dose of 0.7 µg/kg/h. When the surgeon removed the plate, the patient Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score was observed.
RESULTS
The Ce of remifentanil ranged from 0.9 to 2.1 ng/mL for the patients evaluated. The estimated effect-site concentrations of remifentanil associated with a 50% and 95% probability of reaching MOAA/S score of 3 were 1.28 and 2.51 ng/mL, respectively.
CONCLUSIONS
Plate removal of maxilla can be successfully performed without any pain or adverse effects by using the optimal remifentanil effect-site concentration (Ce50 , 1.28 ng/mL; Ce95 , 2.51 ng/mL) combined with sedation using dexmedetomidine.

Keyword

Conscious Sedation, Dexmedetomidine; Plate Removal; Remifentanil

MeSH Terms

Dexmedetomidine
Humans
Maxilla*
Osteotomy
Dexmedetomidine

Figure

• 

  Fig. 1 Predicted probability of reaching a Modified Observer's Alertness/Sedation (MOAA/S) score of 3 plotted against the effect-site concentrations of remifentanil. X: Effect-site concentration of remifentanil when an MOAA/S score of 3 was not reached; O: effect-site concentration of remifentanil of that reached an MOAA/S score of 3. The red solid line indicates the population prediction.

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