Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-24T10:36:27.656Z Has data issue: false hasContentIssue false
  • English
  • Français

The effect of adding two target-controlled concentrations (1–3 ng mL−1) of remifentanil on MACBAR of desflurane

Published online by Cambridge University Press:  04 April 2006

A. Albertin ,
E. Dedola ,
P. C. Bergonzi ,
F. Lombardo ,
T. Fusco  and
G. Torri
A. Albertin
Affiliation:
Vita-Salute University of Milano, Department of Anesthesiology, IRCCS H. San Raffaele, Milan, Italy
E. Dedola
Affiliation:
Vita-Salute University of Milano, Department of Anesthesiology, IRCCS H. San Raffaele, Milan, Italy
P. C. Bergonzi
Affiliation:
Vita-Salute University of Milano, Department of Anesthesiology, IRCCS H. San Raffaele, Milan, Italy
F. Lombardo
Affiliation:
Vita-Salute University of Milano, Department of Anesthesiology, IRCCS H. San Raffaele, Milan, Italy
T. Fusco
Affiliation:
Vita-Salute University of Milano, Department of Anesthesiology, IRCCS H. San Raffaele, Milan, Italy
G. Torri
Affiliation:
Vita-Salute University of Milano, Department of Anesthesiology, IRCCS H. San Raffaele, Milan, Italy
Get access

Extract

Summary

Background and objectives: The aim of this prospective, randomized, double-blind study was to determine the effects of adding two different target-controlled concentrations of remifentanil (1 and 3 ng mL−1) on the desflurane requirement for blunting sympathetic responses after surgical incision (minimum anaesthetic concentration (MACBAR)). Methods: 67 patients, aged 20–50 yr, ASA I, undergoing general anaesthesia for elective abdominal surgery were enrolled and randomly allocated to receive no remifentanil infusion (n = 21) or a target-controlled effect-site concentration of 1 ng mL−1 (n = 24) or 3 ng mL−1 remifentanil (n = 22). All patients were anaesthetized with propofol, cisatracurium and desflurane with a mixture of 60% nitrous oxide in oxygen. Sympathetic responses to surgical incision were determined after a 20-min period of stable end-tidal desflurane and target-controlled remifentanil concentrations. Predetermined end-tidal desflurane concentrations and the MACBAR for each group were determined using an up-and-down sequential-allocation technique. Results: The MACBAR of desflurane was higher in the group receiving no remifentanil (6.25% [95% confidence interval: 5.9–6.5%]) as compared with patients of the groups receiving 1 ng mL−1 (2.7% [2.6–2.8%]; P < 0.001) and 3 ng mL−1 remifentanil (2% [1.9–2.2%]; P < 0.01). When considering a MAC value in this age population and the contribution of 60% nitrous oxide (0.55 MAC), the combined MACBAR values, expressed as multiples of the MAC, were 1.9, 0.8 and 0.6 MAC, in the three groups, respectively. Conclusion: A target-controlled concentration of 1 ng mL−1 remifentanil results in a 57% decrease in the MACBAR of desflurane combined with 60% nitrous oxide. Increasing the target concentration of remifentanil to 3 ng mL−1 produces a further 26% decrease in the MACBAR values of desflurane.

Keywords

ANAESTHETICS INHALATIONAL, desflurane, nitrous oxide, minimum anaesthetic concentrationANALGESICS OPIOID, remifentanilSYMPATHETIC NERVOUS SYSTEMSURGERY ABDOMINAL
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 6 , June 2006 , pp. 510 - 516
Copyright
© 2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

The study was supported by the Vita-Salute University of Milan.

References

Zbinden AM, Petersen-Felix S, Thomson DA. Anesthetic depth defined using multiple noxious stimuli during isoflurane/oxygen anesthesia: II. Hemodynamic responses. Anesthesiology 1994; 80: 261–267.Google Scholar
Katoh T, Ikeda K. The effects of fentanyl on sevoflurane requirements for loss of consciousness and skin incision. Anesthesiology 1998; 88: 18–24.Google Scholar
Daniel M, Weiskopf RB, Noorani M, Eger EI. Fentanyl augments the blockade of the sympathetic response to incision (MAC-BAR) produced by desflurane and isoflurane: desflurane and isoflurane MAC-BAR without and with fentanyl. Anesthesiology 1998; 88: 43–49.Google Scholar
Katoh T, Kobayashi S, Suzuki A, Iwamoto T, Bito H, Ikeda K. The effects of fentanyl on sevoflurane requirements for somatic and sympathetic responses to surgical incision. Anesthesiology 1999; 90: 398–405.Google Scholar
Katoh T, Nakajima Y, Moriwaki G et al. Sevoflurane requirements for tracheal intubation with and without fentanyl. Br J Anesth 1999; 82: 561–565.Google Scholar
Glass PSA, Hardman D, Kamiyama Y et al. Preliminary pharmacokinetics and pharmacodynamics of an ultra-short-acting opioid: remifentanil (GI87084B). Anesth Analg 1993; 77: 1031–1040.Google Scholar
Albertin A, Casati A, Deni F et al. Clinical comparison of either small doses of fentanyl or remifentanil for blunting cardiovascular changes induced by tracheal intubation. Minerva Anesthesiol 2000; 66: 691–696.Google Scholar
Casati A, Albertin A, Fanelli G et al. A comparison of remifentanil and sufentanil as adjuvants during sevoflurane anesthesia with epidural analgesia for upper abdominal surgery: effects on postoperative recovery and respiratory function. Anesth Analg 2000; 91: 1269–1273.Google Scholar
Matute E, Alsina E, Roses R, Blanc G, Perez-Hernandez C, Gilsanz F. An inhalation bolus of sevoflurane versus an intravenous bolus of remifentanil for controlling hemodynamic responses to surgical stress during major surgery: a prospective randomized trial. Anesth Analg 2002; 94: 1217–1222.Google Scholar
De Castro V, Godet G, Mencia G, Raux M, Coriat P. Target-controlled infusion for remifentanil in vascular patients improves hemodynamics and decreases remifentanil requirement. Anesth Analg 2003; 96: 33–38.Google Scholar
Glass PS, Glen JB, Kenny GN, Schuttler J, Shafer SL. Nomenclature for computer-assisted infusion devices. Anesthesiology 1997; 86: 1430–1431.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
Minto CF, Schnider TW, Shafer SL. Pharmacokinetics and pharmacodynamics of remifentanil: II. Model application. Anesthesiology 1997; 86: 24–33.Google Scholar
Nakata Y, Goto T, Ishiguro Y, Terui K, Niimi Y, Morita S. Anesthetic doses of sevoflurane to block cardiovascular responses to incision when administered with xenon or nitrous oxide. Anesthesiology 1999; 91: 369–373.Google Scholar
Dixon JW. Staircase bioassay: the up-and-down method. Neurosci Biobehavioral Rev 1991; 15: 47–50.Google Scholar
Katoh T, Ikeda K. The minimum alveolar anesthetic concentration (MAC) of sevoflurane in humans. Anesthesiology 1987; 66: 301–303.Google Scholar
Wetherill GB. Sequential estimation of quantal response curves. J R Stat Soc 1963; B25: 1–48.Google Scholar
Choi SC. Interval estimation of the LD50 based on an up-and-down experiment. Biometrics 1990; 46: 485–492.Google Scholar
Jung H, Choi SC. Sequential method of estimating the LD50 using a modified up-and-down rule. J Biopharm Stat 1994; 4: 19–30.Google Scholar
Roizen MF, Horrigan RW, Frazer BM. Anesthetic doses blocking adrenergic (stress) and cardiovascular responses to incision: MAC BAR. Anesthesiology 1981; 54: 390–398.Google Scholar
Eger EI. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake. Anesth Analg 2001; 93: 947–953.Google Scholar
Albertin A, Casati A, Bergonzi P, Fano G, Torri G. Effects of two target-controlled concentrations (1 and 3 ng/ml) of remifentanil on MAC(BAR) of sevoflurane. Anesthesiology 2004; 100 (2): 255–259.Google Scholar
Schneider G, Sebel PS. Monitoring depth of anaesthesia. Eur J Anaesthesiol 1997; 15: (Suppl) 21–28.Google Scholar
Shafer A, Doze VA, Shafer SL, White PF. Pharmacokinetics and pharmacodynamics of propofol infusions during general anesthesia. Anesthesiology 1988; 69: 348–356.Google Scholar
Westmoreland CL, Hoke JF, Sebel PS, Hug Jr CC, Muir KT. Pharmacokinetics of remifentanil (GI87084B) and its major metabolite (GI90291) in patients undergoing elective inpatient surgery. Anesthesiology 1993; 79: 893–903.Google Scholar
Mertens MJ, Engbers FHM, Burm AGL, Vuyk J. Predictive performance of computer-controlled infusion of remifentanil during propofol/remifentanil anaesthesia. Br J Anaesth 2003; 90: 132–141.Google Scholar