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Jeong J, Park C, Yoon Y, Lee D, Cho S. Randomized comparison of effects of two different remifentanil dose on surgical conditions during endoscopic sinus surgery. BMC Anesthesiol 2023; 23:292. [PMID: 37644385 PMCID: PMC10464051 DOI: 10.1186/s12871-023-02253-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The combination of propofol and remifentanil results in better surgical field conditions during endoscopic sinus surgery than inhalation anesthesia. This study compared surgical field conditions between two groups receiving low or high concentration of remifentanil and hemodynamic variables using non-invasive cardiac monitoring. METHODS Fifty-four patients between ASA I or II, were randomly assigned to either the high-concentration remifentanil group (HR), effect-site concentration of 8 ng/mL or the low-concentration remifentanil group(LR), effect-site concentration of 4 ng/mL. Surgical condition was evaluated using the Boezaart Surgical Field Grading Scale presented by Boezaart. Cardiac output was measured using non-invasive cardiac monitoring (CSN-1901). RESULTS In terms of surgical conditions, the HR group showed significantly lower values than the LR group (p = 0.021) at 90 min after the start of surgery. Heart rate was significantly lower in the HR group than the LR group at 30, 60, and 90 min after the start of surgery (30 min; p = 0.005, 60 min; p = 0.002, 90 min; p = 0.001). There was a statistically significant decrease of cardiac output in the HR group compared to the LR group immediately after endotracheal intubation and at 30, 60, and 90 min after the start of surgery (Base; P = 0.222, Intubation; P = 0.016, 30 min; p = 0.014, 60 min; P = 0.012, 90 min; P = 0.008). However, in the case of stroke volume, there was no significant difference between the two groups in all measurements. CONCLUSION When comparing the HR group and the LR group, the surgical condition was improved at 90 min after the start of surgery. MAP was lower in the HR group and this was a result of reduction in cardiac output primarily attributed to the decrease in heart rate rather than a decrease in stroke volume. TRIAL REGISTRATION Clinical Trial Registry of the Republic of Korea (KCT0006453).
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Affiliation(s)
- JinHyeok Jeong
- Department of Otorhinolaryngology, Hanyang University Guri Hospital, Guri-Si, Gyeonggi-Do, Republic of Korea
| | - ChanWoo Park
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, 249-1, Gyomun-Dong, Guri-Si, Gyeonggi-Do, 471-701, Republic of Korea
| | - YoungJoon Yoon
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, 249-1, Gyomun-Dong, Guri-Si, Gyeonggi-Do, 471-701, Republic of Korea
| | - DoJae Lee
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, 249-1, Gyomun-Dong, Guri-Si, Gyeonggi-Do, 471-701, Republic of Korea
| | - SangYun Cho
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, 249-1, Gyomun-Dong, Guri-Si, Gyeonggi-Do, 471-701, Republic of Korea.
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Seddighi R, Geist A, Knych H, Sun X. The effect of remifentanil infusion on sevoflurane minimum alveolar concentration-no movement (MAC NM) and bispectral index in dogs. Vet Anaesth Analg 2023; 50:121-128. [PMID: 36641329 DOI: 10.1016/j.vaa.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine the effect of remifentanil infusion on the minimum alveolar concentration of sevoflurane preventing movement (SEVOMACNM) and bispectral index (BIS) in dogs. STUDY DESIGN Prospective, unmasked study. ANIMALS A total of 10 adult Beagle dogs weighing 9.0 ± 1.1 kg. METHODS Dogs were anesthetized with sevoflurane and baseline SEVOMACNM was determined. Remifentanil was infused at 5, 10 and 20 μg kg-1 hour-1, in sequence, with 20 minutes washout between infusions. Variables monitored throughout anesthesia included heart rate (HR), oscillometric blood pressure, end-tidal partial pressure of carbon dioxide, end-tidal sevoflurane concentration (Fe'Sevo) and BIS. SEVOMACNM after remifentanil infusion (SEVOMACNM-REMI) determination started 20 minutes after the start of each infusion. Venous blood samples were collected for plasma remifentanil concentration determination at baseline, SEVOMACNM-REMI determination time points, and 20 minutes after each infusion was stopped. A mixed model analysis was used to determine the effect of remifentanil infusion on response variables. The relationships between BIS and Fe'Sevo, plasma remifentanil concentrations and the percentage decrease in baseline SEVOMACNM were evaluated (p < 0.05). RESULTS The overall SEVOMACNM at baseline was 2.47 ± 0.11%. Addition of remifentanil at all infusion rates significantly decreased SEVOMACNM, but the medium and high doses resulted in significantly greater decreases in SEVOMACNM than the lower dose. There was no difference in SEVOMACNM percentage change between infusions 10 and 20 μg kg-1 hour-1. Plasma remifentanil concentrations were significantly different in all infusion rates. Baseline BIS value was 70 ± 1 and was lower than the BIS values recorded during all remifentanil infusions. BIS values were not significantly different among infusion rates. HR was lower and mean arterial pressure was higher during remifentanil infusions than at baseline. CONCLUSIONS AND CLINICAL RELEVANCE All remifentanil infusions decreased SEVOMACNM in dogs. Remifentanil infusion at any rate studied did not reduce BIS values.
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Affiliation(s)
- Reza Seddighi
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA.
| | - Anthony Geist
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - Heather Knych
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Xiaocun Sun
- Office of Information and Technology, University of Tennessee, Knoxville, TN, USA
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Hayakawa Y, Fujii-Abe K, Nakano T, Suzuki M, Kawahara H. Severe Bradycardia Occurring After Assisted Mouth Opening: A Case Report. Anesth Prog 2022; 69:46-48. [PMID: 35377933 DOI: 10.2344/anpr-68-03-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/29/2021] [Indexed: 11/11/2022] Open
Abstract
We report a case of severe bradycardia during general anesthesia due to reduced atrioventricular conduction capacity believed to have been caused by the trigeminocardiac reflex (TCR). A 46-year-old woman was scheduled for intraoral scar revision under general anesthesia. When the surgeon opened her mouth intraoperatively, the patient's blood pressure immediately increased, and she developed significant bradycardia and a transient Mobitz type II second-degree atrioventricular block. It was assumed that the mandibular division of the trigeminal nerve (V-3) was stimulated by the surgeon stretching the patient's mouth open while remifentanil simultaneously provided sympatholytic effects, resulting in activation of the TCR. The patient quickly responded well to atropine and had no additional complications.
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Affiliation(s)
- Yoshio Hayakawa
- Department of Dental Anesthesiology, School of Dental Medicine Tsurumi University, Kanagawa, Japan
| | - Keiko Fujii-Abe
- Department of Dental Anesthesiology, School of Dental Medicine Tsurumi University, Kanagawa, Japan
| | - Takuya Nakano
- Department of Dental Anesthesiology, School of Dental Medicine Tsurumi University, Kanagawa, Japan
| | - Masayuki Suzuki
- Department of Dental Anesthesiology, School of Dental Medicine Tsurumi University, Kanagawa, Japan
| | - Hiroshi Kawahara
- Department of Dental Anesthesiology, School of Dental Medicine Tsurumi University, Kanagawa, Japan
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Akashi N, Murahata Y, Hosokawa M, Hikasa Y, Okamoto Y, Imagawa T. Cardiovascular and renal effects of constant rate infusions of remifentanil, dexmedetomidine and their combination in dogs anesthetized with sevoflurane. J Vet Med Sci 2020; 83:285-296. [PMID: 33310997 PMCID: PMC7972892 DOI: 10.1292/jvms.20-0457] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
We evaluated changes in cardiovascular and renal functions as well as arginine vasopressin (AVP) secretion, with remifentanil and dexmedetomidine administration alone or in combination in sevoflurane-anesthetized dogs. Six healthy adult Beagle dogs received one of the following four treatments in a randomized crossover study: saline (C), remifentanil alone at successively increasing doses (R; 0.15, 0.60, and 2.40 µg/kg/min), dexmedetomidine alone (D; 0.5 µg/kg intravenously for initial 10 min followed by a constant rate infusion at 0.5 µg/kg/hr), and a combination of remifentanil and dexmedetomidine at the above-mentioned doses (RD). Sevoflurane doses were adjusted to 1.5 times of minimum alveolar concentration (MAC) equivalent according to MAC-sparing effects with remifentanil and dexmedetomidine as previously reported. Cardiovascular measurements, renal function data, and plasma AVP concentrations were determined before and every 60 min until 180 min after drug administration as per each treatment. In the R, D and RD, heart rate significantly decreased and mean arterial pressure significantly increased from baseline or with C. Cardiac index significantly decreased and systemic vascular resistance index increased with D and RD. Oxygen extraction ratio, renal blood flow, and glomerular filtration rate were not affected. The plasma AVP concentrations significantly decreased in D and RD, but increased in R. Only in D, the natriuresis was elicited. The combination of remifentanil and dexmedetomidine in sevoflurane-anesthetized dogs was acceptable in terms of the hemodynamics, oxygenation, and renal function. Remifentanil may interfere with dexmedetomidine-induced diuresis and inhibition of AVP secretion.
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Affiliation(s)
- Natsuki Akashi
- Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, 4-101 Koyama-Minami, Tottori, Tottori 680-8553, Japan
| | - Yusuke Murahata
- Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, 4-101 Koyama-Minami, Tottori, Tottori 680-8553, Japan
| | - Masahumi Hosokawa
- Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, 4-101 Koyama-Minami, Tottori, Tottori 680-8553, Japan
| | - Yoshiaki Hikasa
- Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, 4-101 Koyama-Minami, Tottori, Tottori 680-8553, Japan
| | - Yoshiharu Okamoto
- Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, 4-101 Koyama-Minami, Tottori, Tottori 680-8553, Japan
| | - Tomohiro Imagawa
- Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, 4-101 Koyama-Minami, Tottori, Tottori 680-8553, Japan
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Matsushima M, Kimura S, Kitaura A, Hamasaki S, Iwamoto T, Mino T, Masui K, Nakao S. Propofol suppresses the His-ventricular conduction in paediatric patients. J Clin Pharm Ther 2020; 46:433-439. [PMID: 33098128 PMCID: PMC7983984 DOI: 10.1111/jcpt.13302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/01/2020] [Accepted: 10/06/2020] [Indexed: 12/03/2022]
Abstract
What is known and objective Propofol is the most commonly used intravenous anaesthetic worldwide and is considered to be safe for all ages. However, there have been some reports that propofol induces severe atrioventricular (AV) blocks in humans and some studies demonstrated that propofol suppressed the cardiac conduction system in animals. A precise mechanism by which the block is induced has not been elucidated yet in humans. The objective of this study was to investigate the effects of propofol on the cardiac conduction system and the cardiac autonomic nervous balance in children. Methods We enrolled 23 paediatric patients (age: 6‐15 years; males: 16, females: 7) who were scheduled to undergo radiofrequency catheter ablation (RFCA) under general anaesthesia. Anaesthesia was induced with 2 mg/kg propofol and 0.5 µg/kg/min remifentanil, and tracheal intubation was performed with the aid of 1 mg/kg rocuronium. Anaesthesia was maintained with 5‐7 mg/kg/h propofol and 0.2 µg/kg/min remifentanil during the RFCA. After the completion of the RFCA, anaesthesia was further maintained with 5 mg/kg/h propofol and 0.2 µg/kg/min remifentanil for at least 10 min (LC: low propofol concentration state), followed by the injection of 2 mg/kg propofol and the infusion of 10 mg/kg/h propofol for 10 min (HC: high propofol concentration state). The sinus node recovery time (SNRT), sinoatrial conduction time (SACT), atrial‐His (AH) interval and the His‐ventricular (HV) interval were measured at the end of both the LC and HC. Cardiac autonomic regulation was simultaneously assessed based on heart rate variability. Results and discussion Propofol significantly suppressed intrinsic cardiac HV conduction, but did not affect the SNRT, SACT or the AH interval. As HV blocks, which occur below the His bundle, are often life‐threatening, the HV conduction delay may be a cause of severe AV blocks induced by propofol. Propofol directly suppressed parasympathetic nerve activity, and sympathetic nerve activity was also suppressed. What is new and conclusion These results indicate that propofol suppresses the HV conduction and might help to elucidate the mechanism by which propofol causes lethal AV blocks.
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Affiliation(s)
- Mayuka Matsushima
- Department of Anesthesiology, Faculty of Medicine, Kindai University, OsakaSayama, Osaka, Japan
| | - Seishi Kimura
- Department of Anesthesiology, Faculty of Medicine, Kindai University, OsakaSayama, Osaka, Japan
| | - Atsuhiro Kitaura
- Department of Anesthesiology, Faculty of Medicine, Kindai University, OsakaSayama, Osaka, Japan
| | - Shinichi Hamasaki
- Department of Anesthesiology, Faculty of Medicine, Kindai University, OsakaSayama, Osaka, Japan
| | - Tatsushige Iwamoto
- Department of Anesthesiology, Faculty of Medicine, Kindai University, OsakaSayama, Osaka, Japan
| | - Takashi Mino
- Department of Anesthesiology, Faculty of Medicine, Kindai University, OsakaSayama, Osaka, Japan
| | - Kenichi Masui
- Department of Anesthesiology, Showa University School of Medicine, Shinagawa, Tokyo, Japan
| | - Shinichi Nakao
- Department of Anesthesiology, Faculty of Medicine, Kindai University, OsakaSayama, Osaka, Japan
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Liu YH, Hu XB, Yang XM, Wang YW, Deng M. Comparing remifentanil and sufentanil in stress reduction during neurosurgery: a randomised controlled trial. Int J Clin Pharm 2020; 42:1326-1334. [PMID: 32686050 DOI: 10.1007/s11096-020-01094-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/01/2020] [Indexed: 12/01/2022]
Abstract
Background In most scenarios, anaesthesiologists titrate opioids to control nociceptive surgical stress based on intraoperative haemodynamic changes. Remifentanil was reported to cause more profound cardiovascular depression than sufentanil. A concern is that this direct cardiovascular depression might counteract the hypertension and tachycardia caused by surgical manipulation and mask inadequate analgesia. Objective To compare remifentanil and sufentanil, titrated to maintain a comparable haemodynamic range (within 20% of baseline) and combined with the same propofol regimen, in stress reduction measured as plasma levels of putative mediators of surgical stress. Setting Huashan Hospital of Fudan University, Shanghai, China. Method Forty-five patients undergoing supratentorial glioma resection were randomised to the remifentanil group or the sufentanil group. Main outcome measures Plasma concentrations of cortisol, epinephrine, norepinephrine, interleukin-6, interleukin-10 and lymphocyte counts were analysed before anaesthesia, 1 h after incision, at the end of surgery and 24 h after incision using enzyme-linked immunosorbent assay and an automatic haematology analyser. Recovery profiles during emergence from anaesthesia were also compared. Results Except for a lower epinephrine concentration in the remifentanil group 24 h after incision (median [interquartile range], 4.2 [3.4-6.1] vs. 8.4 [4.8-12.5] ng/ml; P = 0.003), stress biomarkers were not significantly different between the two groups. Patients in the sufentanil group had lower grades in coughing, restlessness (P = 0.001 and < 0.001, respectively) and a lower incidence of postoperative shivering (P = 0.007). Conclusion Compared to that of sufentanil, the direct cardiovascular depression of remifentanil does not mask the clinical manifestation of inadequate analgesia when both drugs are titrated according to haemodynamic variables in neurosurgery.
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Affiliation(s)
- Yi-Heng Liu
- Department of Anesthesiology, Huashan Hospital of Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Xiao-Bing Hu
- Department of Anesthesiology, Huashan Hospital of Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Xia-Min Yang
- Department of Anesthesiology, Huashan Hospital of Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Ying-Wei Wang
- Department of Anesthesiology, Huashan Hospital of Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Meng Deng
- Department of Anesthesiology, Huashan Hospital of Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China.
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Akashi N, Murahata Y, Kishida H, Hikasa Y, Azuma K, Imagawa T. Effects of constant rate infusions of dexmedetomidine, remifentanil and their combination on minimum alveolar concentration of sevoflurane in dogs. Vet Anaesth Analg 2020; 47:490-498. [PMID: 32471632 DOI: 10.1016/j.vaa.2020.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the effects of constant rate infusions (CRIs) of dexmedetomidine and remifentanil alone and their combination on minimum alveolar concentration (MAC) of sevoflurane in dogs. STUDY DESIGN Randomized crossover experimental study. ANIMALS A total of six (three males, three females) healthy, adult neutered Beagle dogs weighing 12.6 ± 1.4 kg. METHODS Anesthesia was induced with sevoflurane in oxygen until endotracheal intubation was possible and anesthesia maintained with sevoflurane using positive-pressure ventilation. Each dog was anesthetized five times and was administered each of the following treatments: saline (1 mL kg-1 hour-1) or dexmedetomidine at 0.1, 0.5, 1.0 or 5.0 μg kg-1 loading dose intravenously over 10 minutes followed by CRI at 0.1, 0.5, 1.0 or 5.0 μg kg-1 hour-1, respectively. Following 60 minutes of CRI, sevoflurane MAC was determined in duplicate using an electrical stimulus (50 V, 50 Hz, 10 ms). Then, CRI of successively increasing doses of remifentanil (0.15, 0.60 and 2.40 μg kg-1 minute-1) was added to each treatment. MAC was also determined after 30 minutes equilibration at each remifentanil dose. Isobolographic analysis determined interaction from the predicted doses required for a 50% MAC reduction (ED50) with remifentanil, dexmedetomidine and remifentanil combined with dexmedetomidine, with the exception of dexmedetomidine 5.0 μg kg-1 hour-1, obtained using log-linear regression analysis. RESULTS The sevoflurane MAC decreased dose-dependently with increasing infusion rates of dexmedetomidine and remifentanil. Remifentanil ED50 values were lower when combined with dexmedetomidine than those obtained during saline-remifentanil. Synergistic interactions between dexmedetomidine and remifentanil for MAC reduction occurred with dexmedetomidine at 0.5 and 1.0 μg kg-1 hour-1. CONCLUSIONS AND CLINICAL RELEVANCE Combined CRIs of dexmedetomidine and remifentanil synergistically resulted in sevoflurane MAC reduction. The combination of dexmedetomidine and remifentanil effectively reduced the requirement of sevoflurane during anesthesia in dogs.
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Affiliation(s)
- Natsuki Akashi
- Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, Tottori, Japan
| | - Yusuke Murahata
- Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, Tottori, Japan.
| | - Hikaru Kishida
- Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, Tottori, Japan
| | - Yoshiaki Hikasa
- Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, Tottori, Japan
| | - Kazuo Azuma
- Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, Tottori, Japan
| | - Tomohiro Imagawa
- Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, Tottori, Japan
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Yoon H, Lee H, Chung J, Park H. Predictive Factors for Hypotension Associated With Supine-to-Prone Positional Change in Patients Undergoing Spine Surgery. J Neurosurg Anesthesiol 2020; 32:140-6. [DOI: 10.1097/ana.0000000000000565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Ke-Li Wu
- National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Tsai-Shan Wu
- Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Zhi-Fu Wu
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Hou-Chuan Lai
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China.
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Murahata Y, Hikasa Y, Hayashi S, Shigematsu K, Akashi N, Osaki T, Tsuka T, Okamoto Y, Imagawa T. The effect of remifentanil on the minimum alveolar concentration (MAC) and MAC derivatives of sevoflurane in dogs. J Vet Med Sci 2018; 80:1086-1093. [PMID: 29780077 PMCID: PMC6068302 DOI: 10.1292/jvms.18-0122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Remifentanil is an ultra-short-acting µ-opioid receptor agonist. The purpose of this study was to determine the relationship of the minimum alveolar concentration (MAC) of
sevoflurane and other MAC derivatives, including the MAC for blocking adrenergic responses (MAC-BAR) and the MAC at which tracheal extubation is occurred (MAC-extubation), with or without
remifentanil infusion. Six healthy adult beagle dogs were randomly anesthetized three times for determining the MAC-BAR (SEVMAC-BAR), MAC (SEVMAC), and MAC- extubation
(SEVMAC-extubation) of sevoflurane under infusion of saline and remifentanil at rates of 0.15, 0.30, 0.60, 1.20, and 2.40 µg/kg/min. The ratio of the
SEVMAC-BAR and SEVMAC and that of the SEVMAC-extubation and SEVMAC were not significantly different at baseline and during treatment. The
MAC-BAR95 and MAC95 decreased in a dose-dependent manner until reaching 1.20 µg/kg/min, and the MAC-extubation5 decreased in a
dose-dependent manner until reaching 0.60 µg/kg/min. The percentage reduction of SEVMAC-BAR, SEVMAC, and SEVMAC-extubation increased in a
dose-dependent manner during remifentanil infusion. The heart rate significantly decreased in the MAC-BAR and MAC groups, and the systolic and mean arterial pressures increased after
remifentanil infusion compared with the baseline values. Remifentanil infusion caused reduction of the SEVMAC-BAR, SEVMAC, and SEVMAC-extubation in a
dose-dependent manner, and ceiling effects were observed in the dogs. Higher doses of remifentanil and sevoflurane were necessary for blocking the sympathetic response to the supramaximal
stimulus to prevent movement and extubation in dogs.
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Affiliation(s)
- Yusuke Murahata
- Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, 4-101 Koyama-Minami, Tottori 680-8553, Japan
| | - Yoshiaki Hikasa
- Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, 4-101 Koyama-Minami, Tottori 680-8553, Japan
| | - Sho Hayashi
- Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, 4-101 Koyama-Minami, Tottori 680-8553, Japan
| | - Koki Shigematsu
- Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, 4-101 Koyama-Minami, Tottori 680-8553, Japan
| | - Natsuki Akashi
- Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, 4-101 Koyama-Minami, Tottori 680-8553, Japan
| | - Tomohiro Osaki
- Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, 4-101 Koyama-Minami, Tottori 680-8553, Japan
| | - Takeshi Tsuka
- Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, 4-101 Koyama-Minami, Tottori 680-8553, Japan
| | - Yoshiharu Okamoto
- Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, 4-101 Koyama-Minami, Tottori 680-8553, Japan
| | - Tomohiro Imagawa
- Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, 4-101 Koyama-Minami, Tottori 680-8553, Japan
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Uchida S, Kadoi Y, Saito S. Effect of Low Dose Remifentanil on Postoperative Pain Relief and Heart Rate Variability in Post-Anaesthesia Care Unit. Turk J Anaesthesiol Reanim 2017; 45:297-302. [PMID: 29114415 DOI: 10.5152/tjar.2017.34341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2017] [Indexed: 11/22/2022] Open
Abstract
Objective Several reports have shown the negligible adverse effects of low-dose remifentanil on the autonomic nervous system. We propose that the administration of low-dose remifentanil would be beneficial without adverse respiratory and hemodynamic effects. This study aimed to examine the effects of low-dose remifentanil on postoperative pain relief and heart rate variability (HRV) after surgery. Methods In total, 20 patients, who underwent breast cancer surgery, were analysed for HRV in the post-anaesthesia care unit (PACU). A sedative dose of remifentanil was continuously infused if patients experienced pain while in PACU. The remifentanil infusion dose was determined by achieving analgesia with no adverse effects on hemodynamics and/or respiration. Variables of low-frequency power, high-frequency power and low-frequency power/high-frequency power ratio were measured before and after the administration of remifentanil. Pain score was expressed as the numeric rating scale (NRS) from 0 to 10. Results The mean dosage of remifentanil administered as a continuous infusion was 0.029±0.0042 μg kg-1 min-1. After remifentanil administration, the value of the NRS decreased from 4.2±2.9 to 2.7±2.6. In addition, the value of high-frequency power increased from 35.6±14.3 to 49.4±3.0. Conclusion The continuous infusion of low-dose remifentanil may reduce post-operative pain scores and trigger the relative activation of the parasympathetic nervous system in post-surgical patients. This indicates that continuous infusion of low-dose remifentanil may be a useful option for postoperative pain relief in cases where postoperative pain control proves inadequate even with the application of regional block technique.
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Affiliation(s)
- Shynma Uchida
- Department of Anesthesia, Gunma Cancer Center, Maebahsi, Japan
| | - Yuji Kadoi
- Department of Anesthesiology, Gunma University Hospital, Maebahsi, Japan
| | - Shigeru Saito
- Department of Anesthesiology, Gunma University Hospital, Maebahsi, Japan
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Nazir M, Salim B, Khan FA. Pharmacological agents for reducing the haemodynamic response to tracheal intubation in paediatric patients: a systematic review. Anaesth Intensive Care 2016; 44:681-691. [PMID: 27832553 DOI: 10.1177/0310057x1604400605] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The primary aim of this review was to assess the effect of pharmacological agents administered to attenuate the haemodynamic response to tracheal intubation in paediatric patients up to 16 years of age undergoing elective surgery. Secondary aims were to identify adverse effects related to these agents, and the agents' roles in decreasing arrhythmias. A systematic search was conducted for articles listed in PubMed, CINAHL or the Cochrane database between January 1980 and June 2014. We included randomised controlled trials where the stated aim of the study included observing the effects of pharmacological agents on the haemodynamic response to tracheal intubation. The outcome measures were changes in mean, systolic and diastolic blood pressure and heart rate, adverse effects of drugs and arrhythmias. Sixteen publications with a total of 1408 children (ages two to 15 years) were identified. These studies varied in methodology and quality. Opioids were the commonest agents used and appeared to obtund the response in a dose-related manner. Fentanyl 2 µg/kg, remifentanil 1 µg/kg, sufentanil 0.1 and 0.2 µg/kg and alfentanil 25 µg/kg blunted the haemodynamic response. Remifentanil 3 µg/kg and sufentanil 0.3 µg/kg were the most effective in obliterating the response but led to hypotension in unstimulated patients. Opioid-related side-effects and arrhythmias were observed in few patients. We recommend that when required, the safe and effective doses identified in this review be used to obtund the haemodynamic response to intubation in paediatric patients, with close observation for the uncommon but recognised side-effects.
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Affiliation(s)
- M Nazir
- Senior Instructor, Anaesthesia, Aga Khan University, Karachi, Sindh, Pakistan
| | - B Salim
- Senior Instructor, Anaesthesia, Aga Khan University, Karachi, Sindh, Pakistan
| | - F A Khan
- Professor, Department of Anaesthesia, Aga Khan University, Karachi, Sindh, Pakistan
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Wujtewicz MA, Hasak L, Twardowski P, Zabul E, Owczuk R. Evaluation of the relationship between baseline autonomic tone and the vagotonic effect of a bolus dose of remifentanil. Anaesthesia 2016; 71:823-8. [PMID: 27150915 DOI: 10.1111/anae.13505] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2016] [Indexed: 12/01/2022]
Abstract
Remifentanil stimulates the parasympathetic nervous system, and patients with increased parasympathetic tone may be at greater risk of bradycardia after its administration. We aimed to establish if adult patients with increased baseline parasympathetic tone were at higher risk of bradycardia and hypotension when given a bolus dose of remifentanil. Seventy adults (age 20-60 years and ASA physical status 1 or 2) were given remifentanil 1 μg.kg(-1) . A Holter ECG monitor was used to assess heart rate changes. Heart rate variability in the frequency domain during the 5 min after remifentanil administration was analysed. Multivariate analysis demonstrated that baseline heart rate was the only independent predictor of remifentanil-induced bradycardia [odds ratio (95% CI) 0.877 (0.796-0.966)]. The vagotonic action of remifentanil does not appear to be related to baseline autonomic tone in adult patients.
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Affiliation(s)
- M A Wujtewicz
- Department of Ophthalmology, Medical University of Gdansk, Gdansk, Poland
| | - L Hasak
- Department of Cardiac Anaesthesiology, Medical University of Gdansk, Gdansk, Poland
| | - P Twardowski
- Department of Anaesthesiology and Intensive Care, Medical University of Gdansk, Gdansk, Poland
| | - E Zabul
- Swissmed Vascular Hospital, Gdansk, Poland
| | - R Owczuk
- Department of Anaesthesiology and Intensive Care, Medical University of Gdansk, Gdansk, Poland
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Demirel S, Celi de la Torre JA, Bruijnen H, Martin E, Popp E, Böckler D, Attigah N. Effect of Superficial Cervical Plexus Block on Baroreceptor Sensitivity in Patients Undergoing Carotid Endarterectomy. J Cardiothorac Vasc Anesth 2016; 30:309-16. [PMID: 26718664 DOI: 10.1053/j.jvca.2015.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Regional anesthesia for patients undergoing carotid endarterectomy is associated with improved intraoperative hemodynamic stability compared with general anesthesia. The authors hypothesized that the reported advantages might be related to attenuated ipsilateral baroreflex control of blood pressure, caused by chemical denervation of the carotid bulb baroreceptor nerve fibers. DESIGN A prospective cohort study. SETTING Single-center university hospital. PARTICIPANTS The study included 46 patients undergoing carotid endarterectomy using superficial cervical block. INTERVENTIONS A noninvasive computational periprocedural measurement of baroreceptor sensitivity was performed in all patients. Two groups were formed, depending on the patients' subjective response to surgical stimulation regarding the necessity of additional intraoperative local anesthesia (LA) administration on the carotid bulb. Group A (block alone) included 23 patients who required no additional anesthesia, and group B (block + LA) consisted of 23 patients who required additional anesthesia. MEASUREMENTS AND MAIN RESULTS Baroreceptor sensitivity showed no significant change after application of the block in both groups (group A: median [IQR], 5.19 [3.07-8.54] v 4.96 [3.1-9.07]; p = 0.20) (group B: median [IQR], 4.47 [3.36-8.09] v 4.53 [3.29-8.01]; p = 0.55). There was a significant decrease in baroreceptor sensitivity in group B after intraoperative LA administration (median [IQR], 4.53 [3.29-8.01] v 3.31 [2.26-7.31]; p = 0.04). CONCLUSIONS Standard superficial cervical plexus block did not impair local baroreceptor function, and, therefore, it was not related to improved cerebral perfusion in awake patients undergoing carotid endarterectomy. However, direct infiltration of the carotid bulb was associated with the expected attenuation of baroreflex sensitivity.
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Affiliation(s)
- Serdar Demirel
- Department of Vascular and Endovascular Surgery, University Hospital of Heidelberg, Heidelberg, Germany;.
| | | | - Hans Bruijnen
- Department of Vascular and Thoracic Surgery, Augsburg City Hospital, University of Ludwig-Maximillians, Munich, Germany
| | - Eike Martin
- Department of Anesthesiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Erik Popp
- Department of Anesthesiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Nicolas Attigah
- Department of Vascular Surgery, City Hospital Triemli, Zurich, Switzerland
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Bayındır S, Gökmen N, Erbayraktar S, Küçükgüçlü S, Yılmaz O, Şahin Ö, Öçmen E, Erdost HA, Sağıroğlu E. Cardioprotective Effects of Remifentanil in a Sympathetic Hyperactivity Model in Rabbits. Turk J Anaesthesiol Reanim 2015; 43:225-31. [PMID: 27366503 DOI: 10.5152/tjar.2015.88319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 10/30/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE In this study, the antiarrhythmic and anti-ischemic effects of a 6 μg kg(-1) min(-1) infusion dose of remifentanil are investigated in a central sympathetic hyperactivity model in rabbits. METHODS In this study, 18 New Zealand rabbits were used. The subjects were randomly divided into three groups (n=6) and received 10 μmol L(-1) glutamate intracerebroventricularly to provide the central sympathetic hyperactivity. In group 1, 10 μmol L(-1) glutamate was used; in group 2, 1 h before L-glutamate injection, 40 mg kg(-1) N (omega)-nitro-L-arginine methyl ester was intravenously (iv) administered; and in group 3, also 1 h before L-glutamate injection, 40 mg kg(-1) N (omega)-nitro-L-arginine methyl ester was iv administered. A 6 μg kg(-1) min(-1) dose of remifentanil infusion was administered 5 min before L-glutamate injection. Heart rate, systolic arterial pressure and mean arterial pressure were measured and recorded. Within 15 min of the intracerebroventricular L-glutamate injection, premature ventricular complexes, bigeminy ventricular arrhythmia, ventricular tachycardia, ST-segment shift and T-wave inversions were recorded. RESULTS When incidences of heart rate, rate pressure product, premature ventricular complexes and bigeminy ventricular arrhythmia were compared between groups, significant differences were not determined. Mean arterial pressure was more significantly increased in group 2 than in the other groups (p<0.05). Ventricular tachycardia, ST-segment shift and T-wave inversions were significantly lower in group 3 than in groups 1 and 2 (p<0.05). CONCLUSION Remifentanil (6 μg kg(-1) min(-1) for 5 min of infusion) prevented life-threatening ventricular tachycardia and electrocardiographic signs of myocardial ischemia in a model of arrhythmia resulting from the association of central sympathetic overactivity.
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Affiliation(s)
- Selen Bayındır
- Department of Anaesthesiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Necati Gökmen
- Department of Anaesthesiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Serhat Erbayraktar
- Department of Neurosurgery, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Semih Küçükgüçlü
- Department of Anaesthesiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Osman Yılmaz
- Department of Animal Research Center, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Ömer Şahin
- Department of Anaesthesiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Elvan Öçmen
- Department of Anaesthesiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Hale Aksu Erdost
- Department of Anaesthesiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Emel Sağıroğlu
- Department of Anaesthesiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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Bergmann I, Szabanowski T, Bräuer A, Crozier TA, Bauer M, Hinz JM. Remifentanil added to sufentanil-sevoflurane anesthesia suppresses hemodynamic and metabolic stress responses to intense surgical stimuli more effectively than high-dose sufentanil-sevoflurane alone. BMC Anesthesiol 2015; 15:3. [PMID: 25670917 PMCID: PMC4322556 DOI: 10.1186/1471-2253-15-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 01/12/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Even extremely high-doses of the potent opioid, sufentanil, cannot reliably suppress stress responses to intense surgical stimuli such as sternotomy. The chemically related opioid remifentanil with its different pharmacokinetics and binding affinities for delta- and kappa-opioid receptors might be more effective in attenuating these responses. METHODS ASA I-III patients scheduled for a surgical procedure with sternotomy under balanced anesthesia (sevoflurane and sufentanil 3 μg.kg(-1) bolus, 0.017 μg.kg(-1).min(-1) infusion) were randomized into two groups. Patients in the study group were supplemented with remifentanil (2 μg.kg(-1) bolus, 2-7 μg.kg(-1).min(-1) infusion) starting ten minutes before sternotomy. Heart rate, arterial blood pressures, cardiac index, ejection fraction, systemic vascular resistance index (SVRI), total body oxygen uptake (VO2) and electric dermal response were measured and compared between the groups. RESULTS 62 patients were studied (study group 32, control group 30). Systolic and mean arterial blood pressures, SVRI, VO2 and skin conductance increased during sternotomy and sternal spread in the control group but not in the study group. Systolic blood pressure increase: 7.5 ± 19 mmHg vs. -3.4 ± 8.9 (p = 0.005); VO2 increase: 31 ± 46% vs. -0.4 ± 32%; incidence of systolic blood pressure increase greater than 15 percent: 20% vs. 3% (p = 0.035) (control vs. study group). CONCLUSION High-dose remifentanil added to sevoflurane-sufentanil anesthesia suppresses the sympathoadrenergic response to sternotomy and sternal spread better than high-dose sufentanil alone. TRIAL REGISTRATION CLINICAL TRIAL NUMBER DRKS00004327, August 31, 2012.
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Affiliation(s)
- Ingo Bergmann
- Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen Medical School, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Torsten Szabanowski
- Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen Medical School, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Anselm Bräuer
- Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen Medical School, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Thomas A Crozier
- Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen Medical School, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Martin Bauer
- Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen Medical School, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - José Maria Hinz
- Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen Medical School, Robert-Koch Str. 40, 37075 Göttingen, Germany
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Abstract
Abstract
Background:
The pupillary light reflex is a critical component of the neurologic examination, yet whether it is present, depressed, or absent is unknown in patients with significant opioid toxicity. Although opioids produce miosis by activating the pupillary sphincter muscle, these agents may induce significant hypercarbia and hypoxia, causing pupillary constriction to be overcome via sympathetic activation. The presence of either “pinpoint pupils” or sympathetically mediated pupillary dilation might prevent light reflex assessment. This study was designed to determine whether the light reflex remains quantifiable during opioid-induced hypercarbia and hypoxia.
Methods:
Ten volunteers were administered remifentanil with a gradually increasing infusion rate and intermittent boluses, until the increasing respiratory depression produced an oxyhemoglobin saturation of 85% or less with associated hypercarbia. Subjects’ heart rate, blood pressure, respiration, and transcutaneous carbon dioxide level were continuously recorded. Arterial blood gases and pupillary measures were taken before opioid administration, at maximal desaturation, and 15 min after recovery.
Results:
The opioid-induced oxygen desaturation (≤85%) was associated with significant hypercarbia and evidence of sympathetic activation. During maximal hypoxia and hypercarbia, the pupil displayed parasympathetic dominance (2.5 ± 0.2 mm diameter) with a robust quantifiable light reflex. The reflex amplitude was linearly related to pupil diameter.
Conclusions:
Opioid administration with significant accompanying hypercarbia and hypoxia results in pupil diameters of 2 to 3 mm and a reduced but quantifiable pupillary light reflex. The authors conclude that the pupillary examination and evaluation of the light reflex remain useful for neurologic assessment during opioid toxicity.
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Shu A, Zhan L, Fang H, Lv E, Chen X, Zhang M, Wang Q. Evaluation of remifentanil anesthesia for off-pump coronary artery bypass grafting surgery using heart rate variability. Exp Ther Med 2013; 6:253-259. [PMID: 23935756 PMCID: PMC3735586 DOI: 10.3892/etm.2013.1108] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 05/01/2013] [Indexed: 01/01/2023] Open
Abstract
Heart rate variability (HRV) was used in the present study to evaluate a target-controlled approach compared with a constant-rate infusion for remifentanil anesthesia during off-pump coronary artery bypass grafting (OP-CABG) surgery. A total of 65 patients with American Society of Anesthesiologists (ASA) physical status II or III, who were aged 60–85 years and scheduled for OP-CABG, were selected for the study. All patients were administered an intramuscular premedication of 10 mg morphine and 0.3 mg scopolamine. In group I, remifentanil was infused using a target-controlled approach at 1.5–5.0 ng/ml, and in group II, remifentanil was infused at a constant-rate of 0.05–1.0 μg/kg/min and at additional single increments of 1 μg/kg when appropriate. The heart rate and other hemodynamic monitoring indices of the patients, including the mean arterial pressure, central venous pressure, pulmonary artery pressure and pulmonary capillary wedge pressure, were monitored at various time points, including prior to induction (T0), at extubation (performed intraoperatively; T7) and at 24 h post-surgery. The HRV indices, including total power (TP), low frequency (LF) and the LF/high frequency (HF) ratio of power (LF/HF), were reduced following induction at T0 and remained low at 24 h post-surgery. At T5 (right coronary or left circumflex artery anastomosis) and T7 (tracheal extubation), all the HRV indices, with the exception of the HF power, were significantly increased (P<0.05). Additionally, the TP, LF and LF/HF values in group II were higher at T5 compared with those in group I (P<0.05). Remifentanil target-controlled infusion is superior to constant-rate infusion in suppressing the stress response during OP-CABG, maintaining the balance of the cardiac autonomic nervous system and promoting the recovery of the autonomic function following surgery.
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Affiliation(s)
- Aihua Shu
- Department of Anesthesiology, Three Gorges University People's Hospital, Yichang, Hubei 443000, P.R. China
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Shirasaka T, Yano T, Kunitake T, Tsuneyoshi I. High-dose remifentanil increases blood pressure and heart rate mediated by sympatho-activation in conscious rats. J Anesth 2012; 27:325-32. [DOI: 10.1007/s00540-012-1515-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 10/28/2012] [Indexed: 10/27/2022]
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Fuyuta M, Nakao S, Takai N, Shiba M, Tanaka Y, Iwamoto T, Kurita T. Sudden cardiac arrest during general anesthesia in an undiagnosed Brugada patient. J Cardiothorac Vasc Anesth 2012; 27:1334-6. [PMID: 23063101 DOI: 10.1053/j.jvca.2012.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Masaki Fuyuta
- Department of Anesthesiology, Kinki University, Osaka, Japan
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Fujii K, Iranami H, Nakamura Y, Hatano Y. High-Dose Remifentanil Suppresses Sinoatrial Conduction and Sinus Node Automaticity in Pediatric Patients Under Propofol-Based Anesthesia. Anesth Analg 2011; 112:1169-73. [DOI: 10.1213/ane.0b013e318210f4ef] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Standing JF, Hammer GB, Sam WJ, Drover DR. Pharmacokinetic-pharmacodynamic modeling of the hypotensive effect of remifentanil in infants undergoing cranioplasty. Paediatr Anaesth 2010; 20:7-18. [PMID: 19825011 DOI: 10.1111/j.1460-9592.2009.03174.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Although remifentanil has been used to induce hypotension during surgery in infants, no pharmacokinetic-pharmacodynamic (PKPD) model exists for its quantitative analysis. Our aim was to determine the quantitative relationship between whole blood remifentanil concentration and its hypotensive effect during surgery in infants. METHODS/MATERIALS We studied seven infants (age 0.3-1 year) who underwent cranioplasty surgery and received remifentanil delivered by a computer-controlled infusion pump during the maintenance of anesthesia. Arterial blood samples to determine remifentanil concentration and mean arterial blood pressure (MAP) measurements were collected. A simultaneous PKPD mixed-effects model was built in NONMEM. RESULTS A total of 77 remifentanil concentrations and 185 MAP measurements were collected. Remifentanil pharmacokinetics was described with a two-compartment model, parameter estimates were 2.99 l x min(-1) x 70 kg(-1) for clearance and 16.23 l x 70 kg(-1) for steady state volume of distribution. Mean baseline MAP was 69.7 mmHg and was decreased as per clinical requirements. A sigmoidal E(max) model driven by an effect compartment described the decrease in MAP, with an estimated concentration to decrease MAP by half (EC(50)) being 17.1 ng x ml(-1). CONCLUSIONS Remifentanil is effective in causing hypotension. The final model predicts that a steady state remifentanil concentration of 14 ng.ml(-1) would typically achieve a 30% decrease in MAP.
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Affiliation(s)
- Joseph F Standing
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
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Zaballos M, Jimeno C, Almendral J, Atienza F, Patiño D, Valdes E, Navia J, Anadón M. Cardiac electrophysiological effects of remifentanil: study in a closed-chest porcine model. Br J Anaesth 2009; 103:191-8. [DOI: 10.1093/bja/aep131] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Liao X, Yang QY, Xue FS, Luo MP, Xu YC, Liu Y, Zhang YM. Bolus dose remifentanil and sufentanil blunting cardiovascular intubation responses in children: a randomized, double-blind comparison. Eur J Anaesthesiol 2009; 26:73-80. [PMID: 19122556 DOI: 10.1097/EJA.0b013e32831a6b2f] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE The present randomized controlled study was designed to compare the efficacy of remifentanil 2 microg kg(-1) and sufentanil 0.2 microg kg(-1) by bolus injection on the cardiovascular response to intubation in healthy children. METHODS One hundred and five children, ASA 1-2 and scheduled for elective plastic surgery under general anaesthesia, were randomly divided into one of two study groups to receive the following treatments in a double-blind manner: remifentanil 2 microg kg(-1) (group R) and sufentanil 0.2 microg kg(-1) (group S). Blood pressure and heart rate (HR) were recorded before anaesthesia induction (baseline values), immediately before intubation (postinduction values), at intubation and every minute for 5 min after intubation. The percentage changes in systolic blood pressure (SBP) and HR relative to baseline values were calculated. The incidences of SBP and HR percentage changes of more than 30% of baseline values during the observation were recorded. RESULTS As compared with baseline values, blood pressure and HR at intubation and their maximum values during the observation increased significantly in group S, but decreased significantly in group R. Blood pressure and HR at intubation and their maximum values during the observation were significantly different between the groups. There were significant differences between the groups in the percentage changes of SBP and HR relative to baseline values and their maximum percentage changes during the observation. The incidences of SBP and HR percentage increases of more than 30% of baseline values were not significantly different between the groups, but the incidences of SBP and HR percentage decreases of more than 30% of baseline values were significantly higher in group R than in group S. CONCLUSION In combination with propofol for anaesthesia induction in children, sufentanil 0.2 microg kg(-1) by bolus injection fails to depress the cardiovascular intubation response. Remifentanil 2 microg kg(-1) by bolus injection can completely abolish the cardiovascular intubation response, but causes more adverse cardiovascular depression.
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Ryu JK, Lee BJ, Yang KA, Jung O. Delayed recovery of neuromuscular blockade by rocuronium in a hypothermic patient during a laparoscopic procedure - A case report -. Korean J Anesthesiol 2009; 56:195-199. [DOI: 10.4097/kjae.2009.56.2.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Ji Keun Ryu
- Department of Anesthesiology and Pain Medicine, Dongkang Hospital, Ulsan, Korea
| | - Byung Jun Lee
- Department of Anesthesiology and Pain Medicine, Dongkang Hospital, Ulsan, Korea
| | - Kyung A Yang
- Department of Anesthesiology and Pain Medicine, Dongkang Hospital, Ulsan, Korea
| | - Ouk Jung
- Department of Anesthesiology and Pain Medicine, Dongkang Hospital, Ulsan, Korea
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Hu Z, Lin P, Liu J, Liao D. Remifentanil induces l-type ca2+ channel inhibition in human mesenteric arterial smooth muscle cells. Can J Anaesth 2008; 55:238-44. [DOI: 10.1007/bf03021508] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Affiliation(s)
- Byung Gun Lim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang Ho Lim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Baumert JH, Hein M, Hecker KE, Satlow S, Schnoor J, Rossaint R. Autonomic cardiac control with xenon anaesthesia in patients at cardiovascular risk. Br J Anaesth 2007; 98:722-7. [PMID: 17468494 DOI: 10.1093/bja/aem083] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The cardiovascular stability found with xenon anaesthesia may be caused by absence of circulatory depression. Xenon may also act directly on autonomic cardiovascular control. METHODS In a prospective, randomized design, 26 patients (ASA class III and IV) with increased cardiac risk were anaesthetized for elective non-cardiac surgery with either xenon (n = 13) or propofol (n = 13), each combined with remifentanil. From intraoperative Holter ECG, 5-min intervals of stable sinus rhythm were analysed at baseline anaesthesia with etomidate/remifentanil, and after 30 and 60 min of propofol or xenon anaesthesia. Target criteria were total power and ratio of low to high frequency power of the heart rate (HR) power spectrum between 0.003 and 0.4 Hz, indicating global activity and sympatho-vagal balance of autonomic modulation of HR. RESULTS When compared with baseline, total power decreased with propofol from 8.6 (1.6) to 7.1 (0.5) and to 7.8 (1.1) ms(2) at 30 and 60 min, respectively, [mean (sd) of logarithmic transform] and was unchanged with xenon (P = 0.02; anova). The low/high frequency power ratio changed from 3.0 (3.5) to 4.3 (4.3) and 4.1 (6.2), respectively, with xenon and from 3.9 (3.6) to 1.8 (1.5) and 1.8 (0.8) with propofol (P = 0.04; generalized linear model test). Mean arterial pressure was significantly higher with xenon throughout (P < 0.001; anova). CONCLUSIONS Propofol caused a decrease in arterial pressure as well as autonomic HR modulation, but xenon did not. The higher arterial pressure with xenon anaesthesia may be explained by less suppression of sympatho-vagal balance.
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Affiliation(s)
- J-H Baumert
- Klinik fuer Anaesthesiologie, Universitaetsklinikum Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
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Cheong SH, Park TS, Lee SE, Kim YH, Lim SH, Lee JH, Lee KM, Choe YK, Kim YJ, Shin CM. Measurement of Hemodynamic Variables using Impedance Cardiography on Remifentanil-Propofol Infusion during Anesthetic Induction. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.53.1.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Soon Ho Cheong
- Department of Anesthesiology and Pain Medicine, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Tae Sik Park
- Department of Anesthesiology and Pain Medicine, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Sang Eun Lee
- Department of Anesthesiology and Pain Medicine, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Young Hwan Kim
- Department of Anesthesiology and Pain Medicine, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Se Hun Lim
- Department of Anesthesiology and Pain Medicine, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Jeong Han Lee
- Department of Anesthesiology and Pain Medicine, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Kun Moo Lee
- Department of Anesthesiology and Pain Medicine, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Young Kyun Choe
- Department of Anesthesiology and Pain Medicine, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Young Jae Kim
- Department of Anesthesiology and Pain Medicine, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Chee Mahn Shin
- Department of Anesthesiology and Pain Medicine, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea
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Tirel O, Chanavaz C, Bansard JY, Carré F, Ecoffey C, Senhadji L, Wodey E. Effect of remifentanil with and without atropine on heart rate variability and RR interval in children. Anaesthesia 2005; 60:982-9. [PMID: 16179043 DOI: 10.1111/j.1365-2044.2005.04298.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Remifentanil can cause bradycardia either by parasympathetic activation or by other negative chronotropic effects. The high frequency (HF) component of heart rate variability (HRV) is a marker of parasympathetic activity. This study aimed to evaluate the effect of remifentanil on RR interval and on HRV in children. Forty children ASA I or II were studied after approval by the human studies committee and informed parental consent was obtained. After stabilisation at sevoflurane 1 MAC, they were randomly divided into two groups: one received a 20 microg.kg(-1) atropine injection (AT + REMI) and the other ringer lactate solution (REMI). Three minutes later, a 1 microg.kg(-1) bolus of remifentanil was administered over 1 min, followed by a continual infusion at 0.25 microg.kg(-1).min(-1) for 10 min increased to 0.5 microg.kg(-1).min(-1) for a further 10 min. A time varying, autoregressive analysis of RR sequences was used to estimate classical spectral parameters: low (0.04-0.15 Hz; LF) and high (0.15-0.45 Hz; HF) frequency, whereas the root mean square of successive differences of RR intervals (rmssd) was derived directly from the temporal sequence. Statistical analyses were conducted by means of the multiple correspondence analysis and with non parametrical tests. Remifentanil induced an RR interval lengthening, i.e. bradycardia, in both groups compared to pretreatment values and was associated with an increase of HF and rmssd only for the REMI group. The parasympathetic inhibition by atropine did not totally prevent remifentanil's negative chronotropic effect. A direct negative chronotropic effect of remifentanil is proposed.
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Affiliation(s)
- O Tirel
- Department of Anaesthesiology and Surgical Intensive Care, LTSI INSERM, Université de Rennes 1, France
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Baumert JH, Hecker KE, Hein M, Reyle-Hahn M, Horn NA, Rossaint R. Effects of xenon anaesthesia on the circulatory response to hypoventilation. Br J Anaesth 2005; 95:166-71. [PMID: 15908452 DOI: 10.1093/bja/aei153] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Circulatory response to hypoventilation is aimed at eliminating carbon dioxide and maintaining oxygen delivery (DO(2)) by increasing cardiac output (CO). The hypothesis that this increase is more pronounced with xenon than with isoflurane anaesthesia was tested in pigs. METHODS Twenty pigs received anaesthesia with xenon 0.55 MAC/remifentanil 0.5 microg kg(-1) min(-1) (group X, n=10) or isoflurane 0.55 MAC/remifentanil 0.5 microg kg(-1)min(-1) (group I, n=10). CO, heart rate (HR), mean arterial pressure (MAP) and left ventricular fractional area change (FAC) were measured at baseline, after 5 and 15 min of hypoventilation and after 5, 15 and 30 min of restored ventilation. RESULTS CO increased by 10-20% with both anaesthetics, with an equivalent rise in HR, maintaining DO(2) in spite of a 20% reduction in arterial oxygen content. Decreased left ventricular (LV) afterload during hypoventilation increased FAC, and this was more marked with xenon (0.60-0.66, P<0.05 compared with baseline and isoflurane). This difference is attributed to negative inotropic effects of isoflurane. Increased pulmonary vascular resistance during hypoventilation was found with both anaesthetics. CONCLUSION The cardiovascular effects observed in this model of moderate hypoventilation were sufficient to maintain DO(2). Although the haemodynamic response appeared more pronounced with xenon, differences were not clinically relevant. An increase in FAC with xenon is attributed to its lack of negative inotropic effects.
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Affiliation(s)
- J-H Baumert
- Anaesthesiology Clinic, Universitaetsklinikum Aachen, Germany.
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Baumert JH, Falter F, Eletr D, Hecker KE, Reyle-Hahn M, Rossaint R. Xenon anaesthesia may preserve cardiovascular function in patients with heart failure. Acta Anaesthesiol Scand 2005; 49:743-9. [PMID: 15954952 DOI: 10.1111/j.1399-6576.2005.00662.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The hypothesis that xenon anaesthesia provided haemodynamic stability was tested in patients with heart failure in a prospective, randomized, single-blind design. METHODS Twenty-six patients scheduled for implantation of a cardioverter-defibrillator (ICD) received xenon 60-65% in oxygen (xenon group, n = 12) or propofol 3 mg/kg/h (propofol group, n = 14), both combined with remifentanil 0.2 microg/kg/min. After induction of anaesthesia with etomidate and remifentanil, heart rate (HR), mean arterial pressure (MAP) and left ventricular ejection fraction (LVEF) were recorded. After 60 min of propofol or xenon anaesthesia, the same parameters were recorded. RESULTS While HR decreased in both groups, MAP was unchanged with xenon (73 vs. 76 mmHg) and decreased with propofol (from 78 to 64 mmHg, P < 0.02). LVEF was stable in both groups [32% vs. 37%, xenon (NS), and 30% vs. 34%, propofol (NS)]. Preload, as measured by end-diastolic volume (EDV), did not change (66 vs. 63 ml with xenon; 79 vs. 81 ml with propofol, both NS). Afterload, as determined by end-systolic pressure-volume product (ESPV), decreased with propofol (6760 vs. 4920 ml mmHg) but not with xenon (4060 vs. 3780 ml mmHg, P < 0.01 between groups). CONCLUSION With propofol, MAP is reduced and LVEF is not increased in spite of reduced afterload. In contrast, MAP and LVEF are maintained with xenon.
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Affiliation(s)
- J-H Baumert
- Klinik fuer Anesthesiologie, Universitaetsklinikum Aachen, Germany.
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Abstract
BACKGROUND It was hypothesized that xenon would stabilize mean arterial pressure (MAP) in haemorrhagic shock, recovery, and volume resuscitation, because a higher MAP has been observed with xenon, when compared with isoflurane anaesthesia. The responses to haemorrhage and subsequent volume replacement were therefore compared between xenon and isoflurane anaesthesia, in pigs. METHODS Pigs were randomized to anaesthesia with xenon 0.55 MAC (group Xe, n=9) or isoflurane 0.55 MAC (group Iso, n=9), each with remifentanil 0.5 microg kg(-1) min(-1). MAP, heart rate, cardiac output (CO), and left ventricular fractional area change (FAC) were collected at control (1), after haemorrhage (20 ml kg(-1)) (2), after 10 min of recovery (3), after volume replacement (4), and 30 min later (5). Data were analysed by two-way repeated measures anova. RESULTS Blood loss decreased MAP (Xe: 103 [21] to 53 [24] mm Hg; Iso: 92 [18] to 55 [14] mm Hg) and CO (Xe: 4.1 [0.8] to 2.6 [0.5] litre min(-1); Iso: 5.1 [1.1] to 3.8 [1.2] litre min(-1)), in spite of significant tachycardia. MAP and CO recovered to about 75% of control, and subsequent volume replacement completely reversed symptoms in both groups, but increased FAC only with xenon. CONCLUSION Haemodynamic response to acute haemorrhage appeared faster with xenon/remifentanil than with isoflurane/remifentanil anaesthesia. In particular MAP decrease and short-term recovery were more marked with xenon (P<0.02). In the xenon group, volume replacement increased FAC compared with control and isoflurane (P<0.02).
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Affiliation(s)
- J-H Baumert
- Klinik fuer Anaesthesiologie, Universitaetsklinikum Aaachen, Pauwelsstrasse 30, D-52074 Aachen, Germany.
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Abstract
INTRODUCTION The aim of this study was to investigate efficacy and tolerability of propofol, remifentanil and cisatracurium or mivacurium in routine anesthetic practice. PATIENTS AND METHODS A total of 6,161 patients scheduled for abdominal or orthopedic surgery were included in this open multicenter phase IV study. Perioperative hemodynamics as well as induction, recovery and discharge times, anesthetics, frequency of PONV and side-effects were studied. RESULTS Quality of induction and maintenance of anesthesia were evaluated by anesthesiologists to be good or very good in 88%. 86% of the patients assessed anesthesia as good or very good. Adverse events were reported for 28 patients (0.45%), with hypotension and bradycardia being most frequent. Recovery was evaluated by anesthesiologists to be good or very good in 88%, surgeons and nursing staff assessed the TIVA as good or very good in 90%. Most frequent postoperative complaints were pain (16.7%), nausea (6.1%), shivering (3.1%) and vomiting (0.7%). CONCLUSIONS The study showed that total intravenous anesthesia using propofol, remifentanil and cisatracurium or mivacurium is safe, tolerable and effective and has a high degree of acceptance.
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Affiliation(s)
- J Schmidt
- Klinik für Anästhesiologie, Friedrich-Alexander-Universität, Erlangen-Nürnberg.
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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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Leone M, Albanèse J, Viviand X, Garnier F, Bourgoin A, Barrau K, Martin C. The Effects of Remifentanil on Endotracheal Suctioning-Induced Increases in Intracranial Pressure in Head-Injured Patients. Anesth Analg 2004; 99:1193-1198. [PMID: 15385374 DOI: 10.1213/01.ane.0000132546.79769.91] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In patients with severe traumatic brain injury, bronchotracheal toilet may be accompanied by deleterious variations in intracranial pressure (ICP). To avoid these effects, IV opioids have been proposed. Twenty mechanically-ventilated patients received 3 ascending IV doses of remifentanil: dose 1 (1 microg/kg bolus, 0.25 microg/kg/min infusion); dose 2 (2 microg/kg bolus, 0.5 microg/kg/min infusion); and dose 3: (4 microg/kg bolus, 1 microg/kg/min infusion). Endotracheal suction was performed 20 min after the beginning of infusion to assess coughing. Heart rate, ICP, mean arterial blood pressure (MAP), cerebral perfusion pressure (CPP), middle cerebral artery mean flow velocity (V(MCA)), and bispectral index were monitored throughout the 30-min study period. Twelve, 15, and 19 patients receiving dose 1, 2, and 3, respectively, required vasopressors to maintain CPP >60 mm Hg. Suctioning resulted in coughing in 16, 15, and 5 patients receiving dose 1, 2, and 3, respectively. An increase in ICP, without change in V(MCA), corresponded to the reduction in MAP consistent with the preservation of autoregulation. Remifentanil used as a continuous infusion in head-injured patients is not an effective drug to block responses to suctioning.
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Affiliation(s)
- Marc Leone
- *Intensive Care Unit and Department of Anesthesiology and the †Department of Biostatistics and Epidemiology, Nord Hospital, Marseilles University Hospital System (AP-HM), Marseilles School of Medicine, Marseilles, France
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Joo HS, Salasidis GC, Kataoka MT, Mazer CD, Naik VN, Chen RB, Levene RG. Comparison of bolus remifentanil versus bolus fentanyl for induction of anesthesia and tracheal intubation in patients with cardiac disease. J Cardiothorac Vasc Anesth 2004; 18:263-8. [PMID: 15232803 DOI: 10.1053/j.jvca.2004.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Large bolus-dose remifentanil may be advantageous for use during induction of anesthesia because of its short duration of effect. Currently, there are little data on the use of large bolus-dose remifentanil because of reports of severe bradycardia and hypotension. The purpose of this study is to compare the hemodynamic effects of bolus remifentanil versus fentanyl with glycopyrrolate for induction of anesthesia in patients with heart disease. DESIGN A randomized, double-blinded study. SETTING A tertiary-care academic medical center. PARTICIPANTS One hundred patients for coronary artery bypass or valvular surgery. INTERVENTION Subjects received either (1) remifentanil, 5 microg/kg, with glycopyrrolate, 0.2 mg, or (2) fentanyl, 20 microg/kg, with 0.2 mg of glycopyrrolate, and both groups also received midazolam, 70 microg/kg, for induction of anesthesia. MEASUREMENTS AND MAIN RESULTS Heart rate, mean arterial pressure, systemic vascular resistance, and cardiac output were similar between the 2 groups during induction of anesthesia and tracheal intubation. The incidence of adverse events such as bradycardia (remifentanil 10%, fentanyl 10%), hypotension (remifentanil 16%, fentanyl 10%), and ischemia (remifentanil 0%, fentanyl 2%) were also similar. A greater percentage of patients in the remifentanil group lost consciousness within 1 minute of opioid administration (86% v 66%, p = 0.034). CONCLUSION Remifentanil with glycopyrrolate is associated with rapid and predictable clinical anesthetic effect, cardiac stability, and the ability to blunt the hemodynamic responses to tracheal intubation. Bolus remifentanil may be a feasible alternative to bolus fentanyl for induction of anesthesia in patients with heart disease because of its short duration of action and its ability to blunt the hemodynamic responses to tracheal intubation.
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Affiliation(s)
- Hwan S Joo
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Canada.
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Abstract
UNLABELLED We explored the possible mechanisms of hypotension during the administration of sedation-analgesia doses of remifentanil in young (ASA physical status I) volunteers (n = 24). Cardiorespiratory and sympathetic variables were collected at baseline and at plasma concentrations of remifentanil (2 and 4 ng/mL). Monitoring included electrocardiogram, heart rate (HR), direct blood pressure, muscle sympathetic nerve activity, and forearm blood flow (FBF). A cold pressor test (1-min hand immersion in ice water) quantified analgesia effectiveness (visual analog scale, 0-100). Visual analog scale to the cold pressor test (62 at baseline) decreased to 27 and 18 during remifentanil infusions. Respiratory rate decreased and end-tidal carbon dioxide (ETCO(2)) increased with increasing doses of remifentanil; HR, direct blood pressure, muscle sympathetic nerve activity, SpO(2) remained unchanged, but FBF increased compared with placebo. In a second study (n = 7), timed respiration was used to maintain ETCO(2) during remifentanil, but FBF still increased. In a third study (n = 11), direct effects of remifentanil on vascular tone were determined with progressive infusions from 1 to 100 micro g/h into the brachial artery; FBF increased significantly from 3.5 to 4.3 mL/min per 100 mL of tissue (approximately 13%-18% increase). Sedative doses of remifentanil resulted in analgesia but no changes in neurocirculatory end-points except FBF. Direct effects of remifentanil on regional vascular tone may play a role in promoting hypotension. IMPLICATIONS Remifentanil occasionally has been associated with hypotension, the mechanism of which is unclear. This study found that remifentanil directly causes the forearm arterial vasculature to dilate.
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Affiliation(s)
- Randa K Noseir
- Department of Anesthesiology, Medical College of Wisconsin and Veterans Affairs Medical Center, Milwaukee
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Chow MYH, Goh MH, Boey SK, Thirugnanam A, Ip-Yam PC. The effects of remifentanil and thoracic epidural on oxygenation and pulmonary shunt fraction during one-lung ventilation. J Cardiothorac Vasc Anesth 2003; 17:69-72. [PMID: 12635063 DOI: 10.1053/jcan.2003.12] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the effects of remifentanil and thoracic epidural analgesia on the hemodynamic changes and pulmonary shunt fraction during one-lung ventilation (OLV) for thoracotomy. DESIGN Prospective, single crossover design. SETTING Tertiary care hospital. PARTICIPANTS Thirty-four patients undergoing OLV for thoracic surgery. INTERVENTIONS During general anesthesia with 2-lung ventilation, one-lung ventilation with remifentanil infusion, and one-lung ventilation with thoracic epidural anesthesia (TEA), hemodynamic parameters and arterial and mixed venous blood gases were taken from the radial and pulmonary artery catheters. During these 3 study periods, cardiac index (CI) was measured using thermodilution technique while shunt fraction (Qs/Qt), alveolar arterial oxygen gradient (A-a O(2)), and systemic (SVRI) and pulmonary vascular resistances indices (PVRI) were calculated. A p value <0.05 was taken to be statistically significant. MEASUREMENTS AND MAIN RESULTS When OLV was instituted, there was a significant decrease in mean arterial blood pressure. Arterial oxygenation decreased, whereas CI and Qs/Qt increased during OLV, but there was no significant difference between remifentanil infusion and thoracic epidural analgesia. CONCLUSIONS Both remifentanil infusion and TEA are suitable for analgesia during thoracic surgery when OLV is used. There was no significant difference in PaO(2) and Qs/Qt during each administration.
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Affiliation(s)
- Mark Yew-Hoong Chow
- Department of Anaesthesia and Surgical Intensive Care Unit, Singapore General Hospital, Singapore.
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Servin F. Remifentanil; from Pharmacological Properties to Clinical Practice. Advances in Modelling and Clinical Application of Intravenous Anaesthesia 2003; 523:245-60. [PMID: 15088856 DOI: 10.1007/978-1-4419-9192-8_22] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abstract
This paper is the twenty-third installment of the annual review of research concerning the opiate system. It summarizes papers published during 2000 that studied the behavioral effects of the opiate peptides and antagonists, excluding the purely analgesic effects, although stress-induced analgesia is included. The specific topics covered this year include stress; tolerance and dependence; learning, memory, and reward; eating and drinking; alcohol and other drugs of abuse; sexual activity, pregnancy, and development; mental illness and mood; seizures and other neurological disorders; electrical-related activity; general activity and locomotion; gastrointestinal, renal, and hepatic function; cardiovascular responses; respiration and thermoregulation; and immunological responses.
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Affiliation(s)
- A L Vaccarino
- Department of Psychology, University of New Orleans, New Orleans, LA 70148, USA.
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Sasao J, Tarver SD, Kindscher JD, Taneyama C, Benson KT, Goto H. In rabbits, landiolol, a new ultra-short-acting beta-blocker, exerts a more potent negative chronotropic effect and less effect on blood pressure than esmolol. Can J Anaesth 2001; 48:985-9. [PMID: 11698317 DOI: 10.1007/bf03016588] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To compare the cardiovascular and sympathetic effects of a new ultra-short-acting, highly cardioselective beta- blocker, landiolol, with esmolol, using an in vivo rabbit model. METHODS Different bolus doses of landiolol (0.3, 1.0, 3.0 and 10.0 mg*kg(-1)) or esmolol (0.5, 1.5 and 5.0 mg*kg(-1)) were given intravenously, and the effects on heart rate (HR) mean arterial pressure (MAP) and renal sympathetic nerve activity (RSNA) were compared. RESULTS Both landiolol and esmolol produced a dose-dependent decrease in HR. The maximum percent reductions of HR were similar with landiolol 3 mg*kg(-1) and esmolol 5 mg*kg(-1) (-14.0 +/- 0.9% and -13.9 +/- 1.4%, mean +/- SE, respectively). HR decreased more rapidly with landiolol than with esmolol. Esmolol produced a dose-dependent decrease in MAP that was not observed with landiolol. The percent maximum reduction of MAP was -38.2 +/- 3.2% with esmolol 5 mg*kg(-1). RSNA increased in a dose-dependent fashion with esmolol, but no changes were noted with landiolol. CONCLUSION These results suggest that, in rabbits, landiolol has slightly more potent negative chronotropic action than esmolol with significantly less effects on blood pressure.
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Affiliation(s)
- J Sasao
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas 66160-7415, USA
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