Cargando…
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...
Autores principales: | , , , , , |
---|---|
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 |
_version_ | 1783258218667966464 |
---|---|
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. |
format | Online Article Text |
id | pubmed-5564158 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | The Korean Dental Society of Anesthsiology |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT kimeunjung optimaleffectsiteconcentrationofremifentanilforminimizingcardiovascularchangescausedbyfiberopticnasotrachealintubation AT jeonhyunwook optimaleffectsiteconcentrationofremifentanilforminimizingcardiovascularchangescausedbyfiberopticnasotrachealintubation AT kimtaekyun optimaleffectsiteconcentrationofremifentanilforminimizingcardiovascularchangescausedbyfiberopticnasotrachealintubation AT baekseunghoon optimaleffectsiteconcentrationofremifentanilforminimizingcardiovascularchangescausedbyfiberopticnasotrachealintubation AT yoonjiuk optimaleffectsiteconcentrationofremifentanilforminimizingcardiovascularchangescausedbyfiberopticnasotrachealintubation AT yoonjiyoung optimaleffectsiteconcentrationofremifentanilforminimizingcardiovascularchangescausedbyfiberopticnasotrachealintubation |