Intravenous anesthesia


Anesthesia and Pain Medicine. 2005 Dec. 9(4): 191-196
ⓒ Korean Society for Intravenous Anesthesia
Hemodynamic Responses according to Different Effect Site Concentration of Remifentanil during Endotracheal Intubation
Kwan Sik Park, M.D.*, Jong Yeop Kim, M.D., Yun Jeong Chae, M.D., Sang Kee Min, M.D., and Bong Ki Moon, M.D.
*Department of Anesthesiology and Pain Medicine, College of Medicine, Jeju University, Jeju; Department of Anesthesiology and Pain Medicine, College of Medicine, Ajou University, Suwon, Korea

Background: We evaluated the hemodynamic responses to laryngoscopy and tracheal intubation using a different effect site concentration of remifentanil when propofol was maintained at the effect site concentration of 5.4mug/ml.
Methods: Sixty patients presenting for elective surgery were randomly assigned to one of three groups according to target effect site concentration of remifentanil. Anesthesia was induced using a target effect site controlled infusion of propofol at a concentration of 5.4mug/ml. In all patients, remifentanil target controlled infusion (TCI) was started at the same time with a target effect site concentration of 0 (control group), 2 (group R2), or 4 ng/ml (group R4). Neuromuscular blockade was provided with rocuronium 0.6 mg/kg. The trachea was intubated under direct laryngoscopy 5 min after induction. Noninvasive arterial blood pressure and heart rate (HR) were recorded at 1 min interval from before induction of anesthesia until 3 min after intubation.
Results: Mean arterial pressure (MAP) and HR in the control group significantly increased at 1 min after intubation (P< 0.05). MAP in group R2 and R4 significantly decreased from 2 min after induction (P<0.05), but MAP in R4 group remained significantly decreased throughout 3 min after intubation, and were lower than the control group (P <0.05).
Conclusions: Effect site concentration of remifentanil at 2 ng/ml administered with propofol TCI at level of 5.4mug/ml attenuates the pressor response to endotracheal intubation, but effect site concentration of remifentanil at 4 ng/ml causes a significant hemodynamic compromise.
Key words : intubation, propofol, remifentanil, target controlled infusion.
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