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Oh J, Park SY, Lee GY, Park JH, Joe HB. Effective dose of remimazolam co-administered with remifentanil to facilitate I-gel insertion without neuromuscular blocking agents: an up-and-down sequential allocation trial. BMC Anesthesiol 2023; 23:81. [PMID: 36927413 PMCID: PMC10018909 DOI: 10.1186/s12871-023-02041-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Remimazolam is a new anesthetic drug developed and is an ultra-short-acting agent with rapid onset and offset. The pharmacology of this drug seems to be ideal for short surgeries eligible for I-gel insertion. Therefore, this study aimed to determine the optimal bolus dose of remimazolam for I-gel insertion when co-administered with remifentanil without neuromuscular blocking agents (NMBAs). METHODS Patients aged 19-65 years with American Society of Anesthesiologists physical status I or II scheduled for general anesthesia were enrolled. The first dose of remimazolam was 0.15 mg/kg and remifentanil was co-administered at an effect-site concentration (Ce) of 3.0 ng/mL. The dose of remimazolam for the following patient was decreased or increased by 0.05 mg/kg depending on the success or failure of I-gel insertion in the previous patient. RESULTS The remimazolam bolus dose required for successful I-gel insertion in 50% of adult patients using modified Dixon's up-and-down method with remifentanil Ce 3.0 ng/mL and no NMBAs was 0.280 ± 0.048 mg/kg. Isotonic regression analysis showed that the 50% and 95% effective doses were 0.244 (83% confidence interval [CI] 0.213-0.313) mg/kg and 0.444 (95% CI 0.436-0.448) mg/kg, respectively. The mean time to loss of consciousness (Modified Observer's Assessment of Alertness/Sedation score < 2) was 52.2 s. Three patients (12.0%) showed a reduction in systolic blood pressure of more than 30% from baseline. CONCLUSIONS Selecting the appropriate dose of remimazolam/remifentanil without NMBAs makes it feasible to insert the I-gel. TRIAL REGISTRATION This study protocol was registered at http://cris.nih.go.kr (KCT0007801, 12th, October, 2022).
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Affiliation(s)
- Juyeon Oh
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164 Worldcup-Ro, Yeongtong-Gu, Suwon, 16499, Republic of Korea
| | - Sung Yong Park
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164 Worldcup-Ro, Yeongtong-Gu, Suwon, 16499, Republic of Korea
| | - Ga Yun Lee
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164 Worldcup-Ro, Yeongtong-Gu, Suwon, 16499, Republic of Korea
| | - Ji Hyun Park
- Office of Biostatics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Republic of Korea
| | - Han Bum Joe
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164 Worldcup-Ro, Yeongtong-Gu, Suwon, 16499, Republic of Korea.
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Joe HB, Kim JY, Kwak HJ, Oh SE, Lee SY, Park SY. Effect of sex differences in remifentanil requirements for the insertion of a laryngeal mask airway during propofol anesthesia: A prospective randomized trial. Medicine (Baltimore) 2016; 95:e5032. [PMID: 27684878 PMCID: PMC5265971 DOI: 10.1097/md.0000000000005032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Remifentanil can improve insertion of a laryngeal mask airway (LMA) during induction with propofol. Recently, it has been suggested that there is a sex difference in opioid requirements for this procedure. The purposes of this study were to determine the effective effect-site concentration (Ce) of remifentanil for the facilitation of LMA insertion in male and female patients during propofol anesthesia without neuromuscular blockade and to evaluate whether there are sex differences in the Ce of remifentanil required for successful LMA insertion. METHODS Forty-eight patients (24 male, 24 female) with American Society of Anesthesiologists physical status 1 or 2, aged 20 to 60 years, scheduled for minor orthopedic surgery under general anesthesia were enrolled. Anesthesia was induced by target-controlled infusion (TCI) of propofol and remifentanil. The target Ce of propofol was 5 μg/mL initially and was reduced to 3.5 μg/mL after loss of consciousness. The Ce of remifentanil given to each patient was determined by the response of the previously tested patient using 0.5 ng/mL as a step size. The 1st patient was tested at a Ce of 3.0 ng/mL of remifentanil. Successful LMA insertion was defined as smooth insertion without patient movement or significant resistance to mouth opening. RESULTS The effective Ce of remifentanil required for successful LMA insertion on 50% of occasions (effective effect-site concentration for 50% [EC50]) as estimated by Dixon method was significantly lower in women (2.18 ± 0.35 ng/mL) than in men (2.82 ± 0.53 ng/mL) (P = 0.02). Using the isotonic regression method, the effective Ce of remifentanil required for successful LMA insertion on 95% of occasions (EC95) (95% confidence interval [CI]) was significantly lower in women (3.38 [3.0-3.48] ng/mL) than in men (3.94 [3.80-3.98] ng/mL). CONCLUSION The Ce of remifentanil required to facilitate successful LMA insertion is higher during propofol induction by TCI in men than in women. When using remifentanil for LMA insertion, patient sex should be taken into account for appropriate dosing.
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Affiliation(s)
- Han Bum Joe
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, World Cup-ro, Yeongtong-gu, Suwon
| | - Jong Yeop Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, World Cup-ro, Yeongtong-gu, Suwon
| | - Hyun Jeong Kwak
- Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, Namdong-gu, Incheon, Republic of Korea
| | - Sang Eon Oh
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, World Cup-ro, Yeongtong-gu, Suwon
| | - Sook Young Lee
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, World Cup-ro, Yeongtong-gu, Suwon
| | - Sung Yong Park
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, World Cup-ro, Yeongtong-gu, Suwon
- Correspondence: Sung Yong Park, Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon 16499, Republic of Korea (e-mail: )
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Choi JB, Kwak HJ, Lee KC, Lee SR, Lee SY, Kim JY. Comparison of remifentanil EC50 for facilitating i-gel and laryngeal mask airway insertion with propofol anesthesia. J Anesth 2016; 30:377-83. [PMID: 26758073 DOI: 10.1007/s00540-015-2133-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/24/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Each supraglottic airway requires different anesthetic depth because it has a specific structure and different compressive force in the oropharyngeal cavity. We designed the study to compare the effect-site concentration (Ce) of remifentanil in 50 % of patients (EC50) for successful insertion of the i-gel second-generation supraglottic airway device with that for laryngeal mask airway (LMA) insertion during target-controlled infusion (TCI) of propofol. METHODS Forty-one female patients were randomized to the i-gel group (n = 20) or the LMA group (n = 21). Anesthesia was induced with propofol Ce of 5 μg/ml and the predetermined remifentanil Ce, and the i-gel or LMA was inserted 5 min later. The remifentanil Ce was estimated by modified Dixon's up-and-down method (initial concentration: 3.0 ng/ml, step size: 0.5 ng/ml). The patient's response to device insertion was classified as either "success (no movement)" or "failure (movement)". RESULTS Using the Dixon's up-and-down method, EC50 of remifentanil Ce for the i-gel (1.58 ± 0.41 ng/ml) was significantly lower than that for LMA (2.25 ± 0.55 ng/ml) (p = 0.038). Using isotonic regression, EC50 (83 % CI) of remifentanil in the i-gel group [1.50 (1.37-1.80) ng/ml] was statistically lower than that in the LMA group [2.00 (1.82-2.34) ng/ml]. EC95 (95 % CI) of remifentanil in the i-gel group [2.38 (1.48-2.50) ng/ml] was statistically lower than that in the LMA group [3.35 (2.58-3.48) ng/ml]. CONCLUSIONS We found that EC50 of remifentanil Ce for i-gel insertion (1.58 ng/ml) was significantly lower than that for LMA insertion (2.25 ng/ml) in female patients during propofol TCI without neuromuscular blockade.
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Affiliation(s)
- Jong Bum Choi
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Jeong Kwak
- Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Kyung Cheon Lee
- Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Se Ryeon Lee
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, San 5, Wonchon-dong, Yeongtong-gu, Suwon, 443-721, Korea
| | - Sook Young Lee
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, San 5, Wonchon-dong, Yeongtong-gu, Suwon, 443-721, Korea
| | - Jong Yeop Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, San 5, Wonchon-dong, Yeongtong-gu, Suwon, 443-721, Korea.
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Zaballos M, Bastida E, Agustí S, Portas M, Jiménez C, López-Gil M. Effect-site concentration of propofol required for LMA-Supreme™ insertion with and without remifentanil: a randomized controlled trial. BMC Anesthesiol 2015; 15:131. [PMID: 26438179 PMCID: PMC4595052 DOI: 10.1186/s12871-015-0115-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 09/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A new supraglottic device, the LMA-Supreme™, has recently become available for clinical use. Information on anaesthetic and co-adjuvant requirements for insertion of the LMA-Supreme™ is limited. The present study aimed to evaluate the optimal effect-site concentration of propofol in 50 % (EC50) of adults necessary for successful insertion of the LMA-Supreme™ and to examine remifentanil's effect on propofol requirements. METHODS Fifty-eight elective patients (aged 18-60 years; ASA (American Society Anaesthesiologists) physical status classification I and II) scheduled for day surgery were randomly assigned to one of two groups: propofol with saline or propofol with remifentanil. Anaesthesia was induced by target-controlled infusion according to predetermined effect-site concentrations of propofol and remifentanil (5 ng.mL(-1)). The EC50 was calculated using Dixon's up-and-down method. Ten minutes following drug administration, LMA-Supreme™ insertion was attempted without the use of muscle relaxant drugs. RESULTS In the propofol + saline group, the EC50 of propofol required for LMA-Supreme™ insertion was 6.32 ± 0.67 μg.mL(-1) (95 % CI, 5.69-6.94 μg.mL(-1)). With the addition of remifentanil at an effect-site concentration of 5 ng.mL(-1), the EC50 of propofol required for LMA-Supreme™ insertion was 2.50 ± 0.80 μg.mL(-1) (95 % CI, 1.82-3.17 μg.mL(-1); p < 0.0001). CONCLUSIONS The propofol requirement for smooth insertion of the LMA-Supreme™ was 60 % less when remifentanil (5 ng.mL(-1)) was co-administered. CLINICAL TRIAL REGISTRATION Identified as NCT01974648 at www.clinicaltrials.gov .
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Affiliation(s)
- Matilde Zaballos
- Department of Toxicology, Faculty of Medicine, Complutense University, Madrid, Spain. .,Department of Anaesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| | - Emilia Bastida
- Department of Anaesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| | - Salomé Agustí
- Department of Anaesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| | - Maite Portas
- Department of Anaesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| | - Consuelo Jiménez
- Department of Anaesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| | - Maite López-Gil
- Department of Anaesthesia, Head Department of Anaesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
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KWAK HJ, MIN SK, YOO JY, PARK KH, KIM JY. The median effective dose of dexmedetomidine for laryngeal mask airway insertion with propofol 2.0 mg/kg. Acta Anaesthesiol Scand 2014; 58:815-9. [PMID: 24961283 DOI: 10.1111/aas.12338] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Dexmedetomidine can be used as a co-induction agent to facilitate laryngeal mask airway (LMA) insertion with minimal effect on respiratory function. The purpose of the study was to determine the median effective dose (ED50) of dexmedetomidine to facilitate LMA insertion during anaesthesia induction with propofol 2.0 mg/kg without neuromuscular blockade. METHODS Twenty-two patients, whose American Society of Anesthesiologists physical status was I or II with ages between 18 and 60 years undergoing minor orthopaedic or gynaecological surgery, were enrolled. After an injection of pre-determined bolus dose of dexmedetomidine over 2 min, anaesthesia was induced with propofol 2.0 mg/kg. The modified Dixon's up-and-down method was used to determine the bolus dose of dexmedetomidine, starting from 0.5 μg/kg (step size; 0.1 μg/kg). LMA insertion was conducted 90 s after the propofol injection, and the response of patients was categorized as either 'success' or 'failure.' RESULTS Insertion of the LMA was unsuccessful in 12 of 22 patients. The ED50 (95% confidence interval) of dexmedetomidine for successful LMA insertion with propofol 2.0 mg/kg was 0.55 (0.44-0.66) μg/kg. Bradycardia occurred in four patients, and seven patients had an apneic episode. CONCLUSION The single dose of dexmedetomidine for successful LMA insertion to be feasible in 50% of patients was 0.55 μg/kg during anaesthesia induction with propofol 2 mg/kg.
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Affiliation(s)
- H. J. KWAK
- Department of Anaesthesiology and Pain Medicine; Gil Medical Center; Gachon University; Incheon Korea
| | - S. K. MIN
- Department of Anaesthesiology Pain Medicine; Ajou University School of Medicine; Suwon Korea
| | - J. Y. YOO
- Department of Anaesthesiology Pain Medicine; Ajou University School of Medicine; Suwon Korea
| | - K. H. PARK
- Department of Anaesthesiology Pain Medicine; Ajou University School of Medicine; Suwon Korea
| | - J. Y. KIM
- Department of Anaesthesiology Pain Medicine; Ajou University School of Medicine; Suwon Korea
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Ryu J, Oh AY, Baek JS, Kim JH, Park SH, Noh JM. Remifentanil dose for laryngeal mask airway insertion with a single standard dose of propofol during emergency airway management in elderly patients. Korean J Anesthesiol 2014; 66:278-82. [PMID: 24851162 PMCID: PMC4028554 DOI: 10.4097/kjae.2014.66.4.278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 09/17/2013] [Accepted: 09/23/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study determined the dose of remifentanil to use during insertion of a Classic™ laryngeal mask airway (LMA, The Laryngeal Mask Co., Nicosia, Cyprus) in elderly patients during emergency airway management when combined with a single dose of propofol. METHODS Patients aged 65-80 years were enrolled. Anesthesia was induced with propofol 1 mg/kg, and then a blinded dose of remifentanil was infused over 30 s after confirming the patient's loss of consciousness. The dose of remifentanil was determined using Dixon's up-and-down method, starting at 0.5 µg/kg (a step size of 0.1 µg/kg). Insertion of the LMA was attempted 60 s after loss of consciousness. RESULTS In total, 23 patients were recruited and the mean age ± standard deviation was 72 ± 3 years. The effective dose for successful LMA insertion in 50% of the patients (ED50) was 0.20 ± 0.05 µg/kg. No patient needed more than 0.3 µg/kg. CONCLUSIONS Remifentanil 0.20 ± 0.05 µg/kg with propofol 1 mg/kg resulted in excellent LMA insertion in 50% of elderly patients without significant hemodynamic changes during emergency airway management.
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Affiliation(s)
- Junghee Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hosptial, Seongnam, Korea
| | - Ah Young Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hosptial, Seongnam, Korea
| | - Ji-Seok Baek
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hosptial, Seongnam, Korea
| | - Jin-Hee Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hosptial, Seongnam, Korea
| | - Sang-Heon Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hosptial, Seongnam, Korea
| | - Jae-Mun Noh
- Department of Anesthesiology and Pain Medicine, Seoul National University Hosptial, Seoul, Korea
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Kwak HJ, Chae YJ, Lee KC, Kim JY. Target-controlled infusion of remifentanil for laryngeal mask airway insertion during sevoflurane induction in adults. J Int Med Res 2013; 40:1476-82. [PMID: 22971499 DOI: 10.1177/147323001204000426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This randomized, double-blind study investigated the suitable target effect-site concentration of remifentanil for laryngeal mask airway (LMA) insertion during inhalation induction with sevoflurane. METHODS Patients aged 18 - 60 years were randomly assigned to one of three groups receiving infusions of normal saline (control group), or infusions with target effect-site remifentanil concentrations of either 1 ng/ml (R1 group) or 2 ng/ml (R2 group), 1 min after the induction of anaesthesia with sevoflurane. LMA insertion was attempted 2 min after induction. Insertion conditions were graded using a six-variable, three-point scale (excellent, intermediate or poor). RESULTS A total of 102 patients were included. The proportion of patients ranked as excellent for the LMA insertion was significantly higher in groups R1 and R2 compared with the control group. The incidence of apnoea was significantly more frequent in the R2 group than in the control or R1 groups. CONCLUSIONS Compared with 1 ng/ml remifentanil or normal saline, target-controlled infusion of 2 ng/ml remifentanil significantly improved the LMA insertion conditions during sevoflurane inhalational induction, although apnoeic episodes were more frequently observed.
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Affiliation(s)
- H J Kwak
- Department of Anaesthesiology and Pain Medicine, Gachon University of Science and Medicine, Gil Medical Centre, Incheon, Republic of Korea
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Kim SH, Choi EM, Chang CH, Kim HK, Chung MH, Choi YR. Comparison of the effect-site concentrations of remifentanil for Streamlined Liner of the Pharynx Airway (SLIPA) versus laryngeal mask airway SoftSealTM insertion during target-controlled infusion of propofol. Anaesth Intensive Care 2011; 39:611-7. [PMID: 21823378 DOI: 10.1177/0310057x1103900412] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study was designed to determine the optimal dose of remifentanil required for the successful insertion of Streamlined Liner of the Pharynx Airway (SLIPA) and to compare it to that required for laryngeal mask airway (LMA) insertion in patients receiving a propofol infusion at a standard effect-site concentration. Fifty-eight patients scheduled to undergo general anaesthesia were randomly assigned to either the SLIPA (n = 29) or LMA (n = 29) group. All patients were premedicated with midazolam 0.05 mg x kg(-1) and glycopyrrolate 0.004 mg x kg(-1) intramuscularly. After the administration of lignocaine 1 mg x kg(-1) intravenously, a propofol infusion was started at an effect-site concentration of 3.5 microg x ml(-1) with a remifentanil infusion without a neuromuscular blocking agent. The remifentanil dose was determined by the modified up-and-down method starting in each group at 4 ng x ml(-1). Six minutes after induction, the airway device was inserted. Airway device insertion was classified as 'success' or 'failure' based on patient response. From the isotonic regression analysis and bootstrap distribution, the EC50 of remifentanil for SLIPA and LMA were 0.93 ng x ml(-1) (95% confidence interval [CI] 0.81 to 1.50 ng x ml(-1) and 1.36 ng x ml(-1) (95% CI 1.19 to 2.06 ng x ml(-1)) respectively, and the EC95 for SLIPA and LMA insertions were 1.90 ng x ml(-1) (95% CI 1.39 to 1.95) and 2.43 ng x ml(-1) (95% CI 1.80 to 2.46 ng x ml(-1)) respectively. Using the 83% CIs from the bootstrap distribution, EC50 for SLIPA was significantly less than that of LMA (0.83 to 1.23 vs 1.26 to 2.00, respectively) (P < 0.05). These findings suggest that the insertion of SLIPA needs about a 32% lower depth of anaesthesia than LMA insertion.
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Affiliation(s)
- S H Kim
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
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Fotopoulou G, Theocharis S, Vasileiou I, Kouskouni E, Xanthos T. Management of the airway without the use of neuromuscular blocking agents: the use of remifentanil. Fundam Clin Pharmacol 2011; 26:72-85. [DOI: 10.1111/j.1472-8206.2011.00967.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
PURPOSE Opioids may affect changes in the corrected QT interval (QTc) during anesthetic induction. This study examine whether a single bolus of remifentanil would prolong QTc after laryngeal mask airway (LMA) insertion during sevoflurane induction. MATERIALS AND METHODS Forty women of American Society of Anesthesiologists physical status 1 (ASA PS1) undergoing gynecological surgery were studied. All patients were induced using three vital capacity inhalation inductions with 5% sevoflurane. Two minutes after induction, the inspiratory concentration of sevoflurane was reduced to 2%. Using double-blinded randomization, patients were allocated into one of two groups, receiving either saline (placebo group, n = 20) or 0.25 μg.kg⁻¹ remifentanil (remifentanil group, n = 20) over a period of thirty seconds. Sixty seconds later, LMA insertion was performed. Recordings were taken with a 12-lead electrocardiogram at baseline, 2 min after induction and 1 and 3 min after LMA insertion. QTc was calculated by Bazett's formula. The mean arterial pressure (MAP) and heart rate (HR) were also measured at each time point. RESULTS The QTc interval was significantly prolonged in the placebo group as compared to the remifentanil group at 1 min after LMA insertion (467.8 ± 16.5 vs. 442.7 ± 21.3 ms, p < 0.001). However, there was no significant difference in QTc at 3 min after LMA insertion between the two groups. MAP and HR were significantly higher in the placebo group (p < 0.001). CONCLUSION A single bolus of remifentanil is safe method to attenuate prolonged QTc associated with insertion of LMA.
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Affiliation(s)
- Eun Sung Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Hae Wone Chang
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine, Seoul, Korea
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Kim MK, Lee JW, Jang DJ, Shin OY, Nam SB. Effect-site concentration of remifentanil for laryngeal mask airway insertion during target-controlled infusion of propofol. Anaesthesia 2009; 64:136-40. [PMID: 19143689 DOI: 10.1111/j.1365-2044.2008.05707.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to determine the effect-site concentration of remifentanil that would provide optimal conditions for successful laryngeal mask airway insertion during a target-controlled infusion (TCI) of propofol at 3.5 microg.ml(-1) without the use of neuromuscular blockade. Five minutes after propofol infusion, remifentanil was infused at a dose determined by a modified Dixon's up-and-down method. Five minutes after remifentanil infusion, the laryngeal mask was inserted. The effect-site concentration of remifentanil for successful laryngeal mask insertion in 50% of adults (EC(50)) was 3.04 (SD 0.49) ng.ml(-1) during a TCI of 3.5 microg.ml(-1) propofol without neuromuscular blockade. From the probit analysis, the EC(50) and EC(95) of remifentanil were 2.84 ng.ml(-1) (95% CI 2.09-3.57 ng.ml(-1)) and 3.79 ng.ml(-1) (95% CI 3.26-9.25 ng.ml(-1)), respectively.
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Affiliation(s)
- M K Kim
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
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Uzun S, Gözaçan A, Canbay O, Ozgen S. Remifentanil and etomidate for laryngeal mask airway insertion. J Int Med Res 2008; 35:878-85. [PMID: 18035006 DOI: 10.1177/147323000703500616] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Etomidate does not depress the upper airway reflexes, making it difficult to insert a laryngeal mask airway (LMA) when using it for anaesthesia. This study investigated the effect of adding remifentanil to etomidate for LMA insertion. Fifty adult patients, undergoing cystoscopy, were randomized to two groups. The propofol-remifentanil group (n=25) received propofol anaesthesia induction (2.5 mg/kg) and a remifentanil bolus of 0.5 microg/kg, followed by a 2-min remifentanil infusion of 0.05 microg/kg per min. The etomidate-remifentanil group (n=25) received etomidate anaesthesia induction (0.3 mg/kg) and remifentanil as described. The LMA was inserted by a blinded anaesthetist who assessed a number of parameters. Only 13 LMAs were inserted at the first attempt in the etomidate-remifentanil group compared with 23 in the propofol-remifentanil group. Gagging, chest rigidity and myoclonus occurred significantly more frequently in the etomidate-remifentanil group. We conclude that the addition of remifentanil to etomidate anaesthesia induction does not improve LMA insertion.
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Affiliation(s)
- S Uzun
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
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Park HJ, Lee JR, Kim CS, Kim SD, Kim HS. Remifentanil halves the EC50 of propofol for successful insertion of the laryngeal mask airway and laryngeal tube in pediatric patients. Anesth Analg 2007; 105:57-61. [PMID: 17578957 DOI: 10.1213/01.ane.0000266447.23037.e4] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Propofol and remifentanil are the drugs of choice for insertion of the supraglottic airway without muscle relaxants for short duration surgery. In this study, we compared propofol concentrations required for insertion of laryngeal mask way (LMA) or laryngeal tube (LT) with and without remifentanil. METHODS We included children scheduled for surgeries lasting <2 h, and assigned them to four groups in a randomized, double-blind manner: LMA with propofol + saline (LMA-P), LT with propofol + saline (LT-P), LMA with propofol + 7.5 ng/mL remifentanil (LMA-PR), LT with propofol +7.5 ng/mL remifentanil (LT-PR). Anesthesia was conducted by target-controlled infusion in determined target effect site concentration of propofol and remifentanil with the STELPUMP program. The EC50 of propofol for airway device placement was determined using Dixon's up-and-down method. The concentration of propofol for consecutive patients in each group was determined by the response of the previous patient, using increments or decrements of 0.2 microg/mL. RESULTS In patients receiving remifentanil, propofol EC50 for insertion of a LMA was 2.57 +/- 0.22 microg/mL and that of LT was 2.59 +/- 0.20 microg/mL (n.s.). In patients receiving saline, the corresponding values were 5.45 +/- 0.21 microg/mL and 5.58 +/- 0.23 microg/mL (n.s.). Conditions were excellent in 64% (9 of 14) and 79% (11 of 14) of patients receiving remifentanil, but in patients receiving saline, the values were 18% (2 of 11) for the LMA and 40.0% (4 of 10) for the LT. CONCLUSIONS Remifentanil 7.5 ng/mL reduced the propofol concentration required for airway insertion by half, and improved conditions for insertion. Propofol concentrations for insertion of the LMA and LT were similar.
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Affiliation(s)
- Hye-Jin Park
- Department of Anesthesiology, College of Medicine, Eulji University, Seoul, Korea
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Abstract
Remifentanil (Ultiva), a fentanyl derivative, is an ultra-short acting, nonspecific esterase-metabolised, selective mu-opioid receptor agonist, with a pharmacodynamic profile typical of opioid analgesic agents. Notably, the esterase linkage in remifentanil results in a unique and favourable pharmacokinetic profile for this class of agent. Adjunctive intravenous remifentanil during general anaesthesia is an effective and generally well tolerated opioid analgesic in a broad spectrum of patients, including adults and paediatric patients, undergoing several types of surgical procedures in both the inpatient and outpatient setting. Remifentanil is efficacious in combination with intravenous or volatile hypnotic agents, with these regimens generally being at least as effective as fentanyl- or alfentanil-containing regimens in terms of attenuation of haemodynamic, autonomic and somatic intraoperative responses, and postoperative recovery parameters. The rapid offset of action and short context-sensitive half-time of remifentanil, irrespective of the duration of the infusion, makes the drug a valuable opioid analgesic option for use during balanced general inhalational or total intravenous anaesthesia (TIVA) where rapid, titratable, intense analgesia of variable duration, and a fast and predictable recovery are required.
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