1.Effect-Site Concentration of Remifentanil for Minimizing Cardiovascular Changes by Inhalation of Desflurane.
Hee Jin JEONG ; Hee Jung BAIK ; Jong Hak KIM ; Youn Jin KIM ; Jae Hyon BAHK
Yonsei Medical Journal 2013;54(3):739-746
PURPOSE: This study aims to investigate the most appropriate effect-site concentration of remifentanil to minimize cardiovascular changes during inhalation of high concentration desflurane. MATERIALS AND METHODS: Sixty-nine American Society of Anesthesiologists physical status class I patients aged 20-65 years were randomly allocated into one of three groups. Anesthesia was induced with etomidate and rocuronium. Remifentanil was infused at effect-site concentrations of 2, 4 and 6 ng/mL in groups R2, R4 and R6, respectively. After target concentrations of remifentanil were reached, desflurane was inhaled to maintain the end-tidal concentration of 1.7 minimum alveolar concentrations for 5 minutes (over-pressure paradigm). The systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) and end-tidal concentration of desflurane were measured for 5 minutes. RESULTS: The end-tidal concentration of desflurane increased similarly in all groups. The SBP, DBP, MAP and HR within group R4 were not significantly different as compared with baseline values. However, measured parameters within group R2 increased significantly 1-3 minutes after desflurane inhalation. The MAP within group R6 decreased significantly at 1, 2, 4, and 5 minutes (p<0.05). There were significant differences in SBP, DBP, MAP and HR among the three groups 1-3 minutes after inhalation (p<0.05). The incidence of side effects such as hyper- or hypo-tension, and tachy- or brady-cardia in group R4 was 4.8% compared with 21.8% in group R2 and 15.0% in group R6. CONCLUSION: The most appropriate effect-site concentration of remifentanil for blunting hemodynamic responses by inhalation of high concentration desflurane is 4 ng/mL.
Adult
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Aged
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Androstanols/adverse effects/pharmacology
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Anesthetics/adverse effects/pharmacology
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Anesthetics, Inhalation/adverse effects/*pharmacology
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Blood Pressure/drug effects
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Etomidate/adverse effects/pharmacology
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Female
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Heart/*drug effects
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Heart Rate/drug effects
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Humans
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Isoflurane/adverse effects/*analogs & derivatives/pharmacology
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Male
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Middle Aged
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Piperidines/adverse effects/*therapeutic use
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Protective Agents/adverse effects/*therapeutic use
2.Antihistamine Pretreatment to Reduce Incidence of Withdrawal Movement After Rocuronium Injection.
Ho Jun LEE ; Sung Jin HAN ; Heezoo KIM ; Il Ok LEE ; Myoung Hoon KONG ; Nan Suk KIM ; Sang Ho LIM ; Mi Kyoung LEE
Journal of Korean Medical Science 2009;24(5):879-882
The purpose of this study was to determine the effectiveness of antihistamine therapy for withdrawal movements caused by rocuronium injection. One hundred seventy one ASA I-II adults undergoing elective surgery were randomly assigned to one of two groups. Patients in the control group (Group C) were premedicated with 2 mL normal saline, and those in the antihistamine group (Group A) were pre-medicated with 2 mL (45.5 mg) pheniramine maleate. After the administration of thiopental sodium 5 mg/kg, rocuronium 0.6 mg/kg was injected. Withdrawal movements were assessed using a four-grade scale. The administration of antihistamine reveals lower grade of withdrawal movement after rocuronium injection.
Adult
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Androstanols/*administration & dosage/adverse effects
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Anesthetics, Intravenous/administration & dosage
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Double-Blind Method
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Female
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Histamine H1 Antagonists/*pharmacology
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Humans
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Incidence
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Injections, Intravenous
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Male
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Middle Aged
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Movement/drug effects/physiology
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Neuromuscular Nondepolarizing Agents/*administration & dosage/adverse effects
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Pain/chemically induced
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Pain Measurement
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Pheniramine/*pharmacology
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Thiopental/administration & dosage