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Concentration of remifentanil needed for tracheal intubation with sevoflurane at 1 MAC in adult patients

Published online by Cambridge University Press:  25 November 2005

F. Sztark ,
F. Chopin ,
A. Bonnet  and
A. M. Cros
F. Sztark
Affiliation:
Centre Hospitalier Universitaire Pellegrin, Département d'Anesthésie-Réanimation I, Bordeaux, France
F. Chopin
Affiliation:
Centre Hospitalier Universitaire Pellegrin, Département d'Anesthésie-Réanimation IV, Bordeaux, France
A. Bonnet
Affiliation:
Centre Hospitalier Universitaire Pellegrin, Département d'Anesthésie-Réanimation IV, Bordeaux, France
A. M. Cros
Affiliation:
Centre Hospitalier Universitaire Pellegrin, Département d'Anesthésie-Réanimation IV, Bordeaux, France
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Extract

Summary

Background and objective: Inhalation induction with sevoflurane provides acceptable conditions for tracheal intubation. Opioids significantly decrease the alveolar concentration needed to achieve tracheal intubation. The purpose of this study was to determine the target concentration of remifentanil providing excellent conditions for tracheal intubation with sevoflurane at 1 minimum alveolar concentration without muscle relaxant. Methods: Twenty-four consecutive patients, aged 18–50 yr, ASA I or II, were studied. Induction of anaesthesia was performed with sevoflurane at age-adjusted minimum alveolar concentration. Remifentanil was simultaneously administered using target-controlled infusion with the Minto model. Target plasma concentration of remifentanil was selected for each patient according to an up-and-down method. Results: The mean target concentration of remifentanil for successful tracheal intubation was 3.3 ng mL−1 (95% confidence interval: 2.6–3.9 ng mL−1). Arterial pressure, heart rate and bispectral index did not increase after tracheal intubation in the group of patients with successful intubation. Conclusions: Remifentanil at 3.3 ng mL−1 together with sevoflurane at 1 minimum alveolar concentration provides excellent conditions for tracheal intubation in 50% of patients.

Keywords

ANAESTHETICS, INHALATION, sevofluraneOPIOIDS, remifentanilINTUBATION INTRATRACHEAL
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 12 , December 2005 , pp. 919 - 924
Copyright
© 2005 European Society of Anaesthesiology

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References

Kimura T, Watanabe S, Asukura N, Inomata S, Okada M, Taguchi M. Determination of end-tidal sevoflurane concentration for tracheal intubation and minimum alveolar anesthetic concentration in adults. Anesth Analg 1994; 79: 378–381.Google Scholar
Katoh T, Nakajima Y, Moriwaki G et al. Sevoflurane requirements for tracheal intubation with and without fentanyl. Br J Anaesth 1999; 82: 561–565.Google Scholar
Muzi M, Colinco MD, Robinson BJ, Ebert TJ. The effects of premedication on inhaled induction of anesthesia with sevoflurane. Anesth Analg 1997; 85: 1143–1148.Google Scholar
Sivalingam P, Kandasamy R, Dhakshinamoorthi P, Madhavan G. Tracheal intubation without muscle relaxant – a technique using sevoflurane vital capacity induction and alfentanil. Anaesth Intens Care 2000; 29: 383–387.Google Scholar
Joo HS, Perks WJ, Belo SE. Sevoflurane with remifentanil allows rapid tracheal intubation without neuromuscular blocking agents. Can J Anesth 2001; 48: 646–650.Google Scholar
Cros AM, Lopez C, Kandel T, Sztark F. Determination of sevoflurane alveolar concentration for tracheal intubation with remifentanil and no muscle relaxant. Anaesthesia 2000; 55: 965–969.Google Scholar
Mollestad KE, Heier T, Steen PA, Raeder JC. 1 MAC-incision sevoflurane prevents explicit awareness during surgical skin incision and tracheal intubation. Acta Anaesthesiol Scand 1998; 42: 1184–1187.Google Scholar
Minto CF, Schnider TW, Egan TD et al. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil. I. Model development. Anesthesiology 1997; 86: 10–23.Google Scholar
Dixon WJ. The up-and-down method for small samples. J Am Stat Assoc 1965; 60: 967–978.Google Scholar
Viby-Mogensen J, Engbaek J, Erikson LI et al. Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents. Acta Anaesthesiol Scand 1996; 40: 59–74.Google Scholar
Paul M, Fisher DM. Are estimates of MAC reliable. Anesthesiology 2001; 95: 1362–1370.Google Scholar
Mencke T, Echternach M, Kleinschmidt S et al. Layngeal morbidity and quality of tracheal intubation – a randomized controlled trial. Anesthesiology 2003; 98: 1049–1056.Google Scholar
Mapleson WW. Effect of age on MAC in humans: a meta-analysis. Br J Anaesth 1996; 76: 179–185.Google Scholar