Effect of a target-controlled infusion of remifentanil in combination with desflurane during the "maintenance" phase of general anesthesia.
10.4097/kjae.2012.63.1.25
- Author:
Myoung Keun SHIN
1
;
Haeng Seon SHIM
;
Geun Young YANG
;
Woo Sung SUNG
Author Information
1. Department of Anesthesiology and Pain Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea. smkeun311@yahoo.co.kr
- Publication Type:Original Article ; Randomized Controlled Trial
- Keywords:
Desflurane;
Remifentanil;
Target-controlled infusion
- MeSH:
Anesthesia, General;
Arterial Pressure;
Blood Pressure;
Extremities;
Heart Rate;
Humans;
Isoflurane;
Orthopedics;
Piperidines
- From:Korean Journal of Anesthesiology
2012;63(1):25-29
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: The goal of this study was to determine the optimal target-controlled concentration of remifentanil combined with desflurane, by using a more widely and decreasing end-tidal concentration of desflurane. METHODS: Ninety ASA I patients, who underwent general anesthesia for elective orthopedic or extremity surgeries, were registered and randomly allocated to receive either a target-controlled concentration of 1 ng/ml (group R1), 2 ng/ml (group R2) remifentanil, or desflurane only without remifentanil infusion (group D). Mean arterial pressure (MAP) and heart rate (HR) were recorded at 5-min intervals from after a 10-15 min period of surgical incision to before a 10-min period prior to the end of an operation. End-tidal concentration of desflurane was increased or decreased in proportion to the changes in MAP and HR. If the value of bispectral index (BIS) was from 60-62 for more than 2 min or systolic blood pressure would fall below 90 mmHg, the patient was excluded from the study to prevent a risk of "explicit awareness" and shock. RESULTS: The end-tidal desflurane concentration was lower in the group receiving 1 ng/ml (5.2 +/- 0.5 vol%; P < 0.001) and 2 ng/ml remifenanil (4.4 +/- 0.5 vol%; P < 0.001) compared to patients in group D (7.9 +/- 0.5 vol%). CONCLUSIONS: We recommend the use of 2 ng/ml or less remifentanil combined with desflurane for decreasing concentrations of desflurane without significant side effects, during the "maintenance" phase, and not during the induction phase of general anesthesia.
