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Optimal effect-site concentration of remifentanil for minimizing cardiovascular changes caused by fiberoptic nasotracheal intubation

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 minimizi...

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Autores principales: Kim, Eun-Jung, Jeon, Hyun-Wook, Kim, Tae-Kyun, Baek, Seung-Hoon, Yoon, Ji-Uk, Yoon, Ji-Young
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Dental Society of Anesthsiology 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5564158/
https://www.ncbi.nlm.nih.gov/pubmed/28879283
http://dx.doi.org/10.17245/jdapm.2015.15.4.221
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author Kim, Eun-Jung
Jeon, Hyun-Wook
Kim, Tae-Kyun
Baek, Seung-Hoon
Yoon, Ji-Uk
Yoon, Ji-Young
author_facet Kim, Eun-Jung
Jeon, Hyun-Wook
Kim, Tae-Kyun
Baek, Seung-Hoon
Yoon, Ji-Uk
Yoon, Ji-Young
author_sort Kim, Eun-Jung
collection PubMed
description 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 (EC(50)) of remifentanil was 3.11 ± 0.38 ng/mL by the Dixon's up-and-down method. From the probit analysis, the EC(50) 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 EC(50) 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.
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spelling pubmed-55641582017-09-06 Optimal effect-site concentration of remifentanil for minimizing cardiovascular changes caused by fiberoptic nasotracheal intubation Kim, Eun-Jung Jeon, Hyun-Wook Kim, Tae-Kyun Baek, Seung-Hoon Yoon, Ji-Uk Yoon, Ji-Young J Dent Anesth Pain Med Original Article 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 (EC(50)) of remifentanil was 3.11 ± 0.38 ng/mL by the Dixon's up-and-down method. From the probit analysis, the EC(50) 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 EC(50) 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. The Korean Dental Society of Anesthsiology 2015-12 2015-12-31 /pmc/articles/PMC5564158/ /pubmed/28879283 http://dx.doi.org/10.17245/jdapm.2015.15.4.221 Text en Copyright © 2015 Journal of Dental Anesthesia and Pain Medicine http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Kim, Eun-Jung
Jeon, Hyun-Wook
Kim, Tae-Kyun
Baek, Seung-Hoon
Yoon, Ji-Uk
Yoon, Ji-Young
Optimal effect-site concentration of remifentanil for minimizing cardiovascular changes caused by fiberoptic nasotracheal intubation
title Optimal effect-site concentration of remifentanil for minimizing cardiovascular changes caused by fiberoptic nasotracheal intubation
title_full Optimal effect-site concentration of remifentanil for minimizing cardiovascular changes caused by fiberoptic nasotracheal intubation
title_fullStr Optimal effect-site concentration of remifentanil for minimizing cardiovascular changes caused by fiberoptic nasotracheal intubation
title_full_unstemmed Optimal effect-site concentration of remifentanil for minimizing cardiovascular changes caused by fiberoptic nasotracheal intubation
title_short Optimal effect-site concentration of remifentanil for minimizing cardiovascular changes caused by fiberoptic nasotracheal intubation
title_sort optimal effect-site concentration of remifentanil for minimizing cardiovascular changes caused by fiberoptic nasotracheal intubation
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5564158/
https://www.ncbi.nlm.nih.gov/pubmed/28879283
http://dx.doi.org/10.17245/jdapm.2015.15.4.221
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