Optimal effect-site concentration of remifentanil for minimizing cardiovascular changes caused by fiberoptic nasotracheal intubation.
10.17245/jdapm.2015.15.4.221
- Author:
Eun Jung KIM
1
;
Hyun Wook JEON
;
Tae Kyun KIM
;
Seung Hoon BAEK
;
Ji Uk YOON
;
Ji Young YOON
Author Information
1. Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Dental Research Institute, Yangsan, Korea. dryoonji@pusan.ac.kr
- Publication Type:Original Article
- Keywords:
Nasotracheal intubation;
Propofol;
Remifentanil
- MeSH:
Analgesics, Opioid;
Anesthesia;
Blood Pressure;
Heart Rate;
Hemodynamics;
Humans;
Intubation*;
Intubation, Intratracheal;
Methods;
Propofol
- From:Journal of Dental Anesthesia and Pain Medicine
2015;15(4):221-227
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Endotracheal intubation induces clinically adverse cardiovascular changes. Various pharmacological strategies for controlling these responses have been suggested with opioids being widely administered. In this study, the optimal effect-site concentration (Ce) of remifentanil for minimizing hemodynamic responses to fiberoptic nasotracheal intubation was evaluated. METHODS: Thirty patients, aged 18-63 years, scheduled for elective surgery were included. Anesthesia was induced with a propofol and remifentanil infusion via target-controlled infusion (TCI). Remifentanil infusion was initiated at 3.0 ng/mL, and the response of each patient determined the Ce of remifentanil for the next patient by the Dixon up-and-down method at an interval of 0.5 ng/mL. Rocuronium was administered after propofol and remifentanil reached their preset Ce; 90 seconds later fiberoptic nasotracheal intubation was initiated. Non-invasive blood pressure and heart rate (HR) were measured at pre-induction, the time Ce was reached, immediately before and after intubation, and at 1 and 3 minutes after intubation. The up-and-down criteria comprised a 20% change in mean blood pressure and HR between just prior to intubation and 1 minute after intubation. RESULTS: The median effective effect-site concentration (EC50) of remifentanil was 3.11 ± 0.38 ng/mL by the Dixon's up-and-down method. From the probit analysis, the EC50 of remifentanil was 3.43 ng/mL (95% confidence interval, 2.90-4.06 ng/mL). In PAVA, the EC50 and EC95 of remifentanil were 3.57 ng/mL (95% CI, 2.95-3.89) and 4.35 ng/mL (95% CI, 3.93-4.45). No remifentanil-related complications were observed. CONCLUSIONS: The EC50 of remifentanil for minimizing the cardiovascular changes and side effects associated with fiberoptic nasotracheal intubation was 3.11-3.43 ng/mL during propofol TCI anesthesia with a Ce of 4 ug/mL.
