Predicted EC50 and EC95 of Remifentanil for Smooth Removal of a Laryngeal Mask Airway Under Propofol Anesthesia.
10.3349/ymj.2015.56.4.1128
- Author:
Ji Young YOO
1
;
Hyun Jeong KWAK
;
Kyung Cheon LEE
;
Go Wun KIM
;
Jong Yeop KIM
Author Information
1. Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea. kjyeop@ajou.ac.kr
- Publication Type:Original Article
- Keywords:
Laryngeal mask airway;
effect-site concentration;
general anesthesia;
remifentanil;
target-controlled infusion;
device removal
- MeSH:
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
- From:Yonsei Medical Journal
2015;56(4):1128-1133
- CountryRepublic of Korea
- Language:English
-
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.
