Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-16T07:25:27.970Z Has data issue: false hasContentIssue false
  • English
  • Français

Target-controlled infusion of remifentanil or fentanyl during extra-corporeal shock-wave lithotripsy

Published online by Cambridge University Press:  13 April 2005

L. I. Cortínez ,
H. R. Muñoz ,
R. De la Fuente ,
D. Acuña  and
J. A. Dagnino
L. I. Cortínez
Affiliation:
Pontificia Universidad Católica de Chile, Department of Anesthesiology, Santiago, Chile
H. R. Muñoz
Affiliation:
Pontificia Universidad Católica de Chile, Department of Anesthesiology, Santiago, Chile
R. De la Fuente
Affiliation:
Pontificia Universidad Católica de Chile, Department of Anesthesiology, Santiago, Chile
D. Acuña
Affiliation:
Pontificia Universidad Católica de Chile, Department of Anesthesiology, Santiago, Chile
J. A. Dagnino
Affiliation:
Pontificia Universidad Católica de Chile, Department of Anesthesiology, Santiago, Chile
Get access

Extract

Summary

Background and objective: Target-controlled infusions (TCIs) of remifentanil and fentanyl in conscious sedation regimes for extra-corporeal shock-wave lithotripsy have not been reported. We estimated the effect site concentrations of remifentanil and fentanyl needed to obtain adequate analgesia in 50% of patients (EC50) and compared both drugs in terms of intra- and post-procedure complications.

Methods: Forty-four adult patients were randomly distributed into two groups: Group R received remifentanil and Group F received fentanyl TCI with initial effect site concentrations of 1.5 and 2 ng mL−1, respectively. Pain was assessed using a 10-point verbal analogue scale and <3 was considered adequate analgesia. Increments or decrements of 0.5 ng mL−1 were then introduced for subsequent patients according to Dixon's up and down method. During the rest of the procedure, TCI was adjusted to maintain verbal analogue scale <3.

Results: Remifentanil and fentanyl EC50 were 2.8 ng mL−1 (95% confidence interval (CI): 1.8–3.7 ng mL−1) and 2.9 ng mL−1 (95% CI: 1.7–4.1 ng mL−1), respectively (n.s.). At EC50, the probability of having a respiratory rate <10 was 4% (95% CI: 0–57%) for remifentanil and 56% (95% CI: 13–92%) for fentanyl. Hypoxaemia, vomiting and sedation were more frequent in Group F during and after the procedure (P < 0.05).

Conclusions: A similar EC50 but more respiratory depression, sedation and PONV were found with fentanyl TCI than with remifentanil TCI.

Keywords

PHARMACOLOGY, fentanyl, remifentanil, target-controlled infusion, respiratory depressionSURGICAL PROCEDURES, extra-corporeal shock-wave lithotripsy
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 1 , January 2005 , pp. 56 - 61
Copyright
© 2005 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.)

References

Gravenstein D. Extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy. Anesthesiol Clin North Am 2000; 18: 953–971.Google Scholar
Coloma M, Chiu JW, White PF, et al. Fast-tracking after immersion lithotripsy: general anesthesia versus monitored anesthesia care. Anesth Analg 2000; 91: 92–96.Google Scholar
Bromage PR, Bonsu AK, el-Faqih SR, Husain I. Influence of Dornier HM3 system on respiration during extracorporeal shock-wave lithotripsy. Anesth Analg 1989; 68: 363–367.Google Scholar
Sa Rego MM, Inagaki Y, White PF. Remifentanil administration during monitored anesthesia care: are intermittent boluses an effective alternative to a continuous infusion? Anesth Analg 1999; 88: 518–522.Google Scholar
Gesztesi Z, Rego MM, White PF. The comparative effectiveness of fentanyl and its newer analogs during extracorporeal shock wave lithotripsy under monitored anesthesia care. Anesth Analg 2000; 90: 567–570.Google Scholar
Beloeil H, Corsia G, Coriat P, Riou B. Remifentanil compared with sufentanil during extra-corporeal shock wave lithotripsy with spontaneous ventilation: a double-blind, randomized study. Br J Anaesth 2002; 89: 567–570.Google Scholar
Shafer SL, Gregg KM. Algorithms to rapidly achieve and maintain stable drug concentrations at the site of drug effect with a computer-controlled infusion pump. J Pharmacokinet Biopharm 1992; 20: 147–169.Google Scholar
Goldman JM. A simple, easy, and inexpensive method for monitoring ETCO2 through nasal cannulae. Anesthesiology 1987; 67: 606.Google Scholar
Minto CF, Schnider TW, Shafer SL. Pharmacokinetics and pharmacodynamics of remifentanil. II. Model application. Anesthesiology 1997; 86: 24–33.Google Scholar
McClain DA, Hug Jr CC. Intravenous fentanyl kinetics. Clin Pharmacol Ther 1980; 28: 106–114.Google Scholar
Dixon W, Massey FJ. Introduction to Statistical Analysis New York, USA: McGraw-Hill, 1969.
Maitre PO, Vozeh S, Heykants J, et al. Population pharmacokinetics of alfentanil: the average dose–plasma concentration relationship and interindividual variability in patients. Anesthesiology 1987; 66: 3–12.Google Scholar
Ausems ME, Vuyk J, Hug Jr CC, Stanski DR. Comparison of a computer-assisted infusion versus intermittent bolus administration of alfentanil as a supplement to nitrous oxide for lower abdominal surgery. Anesthesiology 1988; 68: 851–861.Google Scholar
Paul M, Fisher DM. Are estimates of MAC reliable? Anesthesiology 2001; 95: 1362–1370.Google Scholar
Shafer SL, Varvel JR, Aziz N, Scott JC. Pharmacokinetics of fentanyl administered by computer-controlled infusion pump. Anesthesiology 1990; 73: 1091–1102.Google Scholar
Mertens MJ, Engbers FH, Burm AG, Vuyk J. Predictive performance of computer-controlled infusion of remifentanil during propofol/remifentanil anaesthesia. Br J Anaesth 2003; 90: 132–141.Google Scholar
McEwan AI, Smith C, Dyar O, et al. Isoflurane minimum alveolar concentration reduction by fentanyl. Anesthesiology 1993; 78: 864–869.Google Scholar
Lang E, Kapila A, Shlugman D, et al. Reduction of isoflurane minimal alveolar concentration by remifentanil. Anesthesiology 1996; 85: 721–728.Google Scholar
Puchner W, Egger P, Puhringer F, et al. Evaluation of remifentanil as single drug for awake fiberoptic intubation. Acta Anaesthesiol Scand 2002; 46: 350–354.Google Scholar
Chen SW, Maguire PA, Davies MF, et al. Evidence for mu1-opioid receptor involvement in fentanyl-mediated respiratory depression. Eur J Pharmacol 1996; 312: 241–244.Google Scholar
Joshi GP, Warner DS, Twersky RS, Fleisher LA. A comparison of the remifentanil and fentanyl adverse effect profile in a multicenter phase IV study. J Clin Anesth 2002; 14: 494–499.Google Scholar
Joo HS, Perks WJ, Kataoka MT, et al. A comparison of patient-controlled sedation using either remifentanil or remifentanil–propofol for shock wave lithotripsy. Anesth Analg 2001; 93: 1227–1232.Google Scholar