Changes of Hemodynamics and Bispectral Index by Tracheal Intubation according to Effect-site Concentration of Remifentanil during Propofol Anesthesia.

Lee,  Hong Sik; Song,  Jang Ho; Shinn,  Helen Ki; Han,  Jeong Uk; Jung,  Jong Kwon; Yang,  Chun Woo; Cho,  Byung Kwan

doi:2007.53.5.565

Randomized Controlled Trial

Korean Journal of Anesthesiology 2007;53(5):565-570.
DOI: https://doi.org/10.4097/kjae.2007.53.5.565

Changes of Hemodynamics and Bispectral Index by Tracheal Intubation according to Effect-site Concentration of Remifentanil during Propofol Anesthesia.

Hong Sik Lee, Jang Ho Song, Helen Ki Shinn, Jeong Uk Han, Jong Kwon Jung, Chun Woo Yang, Byung Kwan Cho

¹Department of Anesthesiology and Pain Medicine, College of Medicine, Inha University, Incheon, Korea. snoguy@freechal.com
²Department of Anesthesiology and Pain Medicine, College of Medicine, Konyang University, Daejeon, Korea.

Abstract

BACKGROUND
Combination of propofol and remifentanil is an ideal regimen for total intravenous anesthesia, and the bispectral index (BIS) has been used as an indicator of the sedative state during anesthesia. This study examined the effect of remifentanil on the mean arterial pressure (MAP), heart rate (HR) and BIS to laryngoscopy and tracheal intubation with 4microgram/ml of fixed target effect-site concentration infusion of propofol.
METHODS
In this double-blind study, fifty-one ASA physical status I-II patients, aged 20-60 yr undergoing elective surgery were randomly assigned to one of four groups according to the target effect-site concentration of remifentanil (0, 2, 3, 4 ng/ml). The target-controlled infusion (TCI) of remifentanil was initiated after the effect-site concentration of propofol was maintained with 4microgram/ml. After target effect-site concentration of remifentanil was reached, a neuromuscular blockade was produced by rocuronium 1 mg/kg and tracheal intubation was performed after 90 seconds. MAP, HR and BIS were measured at pre-induction, after reaching target effect-site concentration of propofol and remifentanil, before and after tracheal intubation.
RESULTS
The changes of MAP, HR and BIS after tracheal intubation were negatively correlated with remifentanil effect-site concentration.
CONCLUSIONS
Remifentanil attenuated the hemodynamic responses due to tracheal intubation and decreased BIS after tracheal intubation in a comparable dose-dependent fashion.

Key Words: BIS; propofol; remifentanil; target-controlled infusion; tracheal intubation