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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
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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

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Footnotes

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

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