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Low and moderate remifentanil infusion rates do not alter target-controlled infusion propofol concentrations necessary to maintain anesthesia as assessed by bispectral index monitoring.
Anesth Analg. 2007 Feb; 104(2):325-31.A&A

Abstract

BACKGROUND

We investigated whether the EC(50) (the effective concentration that is required to achieve a response in 50% of patients) of propofol necessary to lower the Bispectral Index (BIS) value to 50 or less was reduced by coadministration of different remifentanil infusion rates.

METHOD

Seventy-two adult ASA I or II patients undergoing endotracheal intubation and target-controlled infusion (TCI) propofol anesthesia were allocated to six groups by stratified randomization. Group B received remifentanil 0.1 mug x kg(-1) x min(-1), Group C 0.15 microg x kg(-1) x min(-1), Group D 0.2 microg x kg(-1) x min(-1), Group E 0.3 microg x kg(-1) x min(-1) and Group F 0.4 microg x kg(-1) x min(-1). Group A served as control and received no remifentanil. The response of the first patient to propofol TCI at 4 microg/mL determined the effect-site concentration of propofol for the next patient in the same remifentanil group (Dixon's "up-and-down" method). If BIS was >50, the next patient received more propofol, and if BIS was < or =50, the next patient received less propofol. The hemodynamic effects of the combinations were also studied.

RESULTS

The EC50 varied from 2.4 to 2.9 microg/mL. No additive effect of remifentanil on the EC50 of propofol was observed. However, there was a wider variation in the response to propofol when the patients received no remifentanil. There was a decrease in heart rate in the remifentanil groups.

CONCLUSION

Infusion of remifentanil did not reduce propofol requirements in the unstimulated anesthetized patient. Propofol TCI levels should not be reduced because remifentanil is coinfused.

Authors+Show Affiliations

Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia, Australia. lpwang@iinet.net.auNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

17242088

Citation

Wang, Lars P., et al. "Low and Moderate Remifentanil Infusion Rates Do Not Alter Target-controlled Infusion Propofol Concentrations Necessary to Maintain Anesthesia as Assessed By Bispectral Index Monitoring." Anesthesia and Analgesia, vol. 104, no. 2, 2007, pp. 325-31.
Wang LP, McLoughlin P, Paech MJ, et al. Low and moderate remifentanil infusion rates do not alter target-controlled infusion propofol concentrations necessary to maintain anesthesia as assessed by bispectral index monitoring. Anesth Analg. 2007;104(2):325-31.
Wang, L. P., McLoughlin, P., Paech, M. J., Kurowski, I., & Brandon, E. L. (2007). Low and moderate remifentanil infusion rates do not alter target-controlled infusion propofol concentrations necessary to maintain anesthesia as assessed by bispectral index monitoring. Anesthesia and Analgesia, 104(2), 325-31.
Wang LP, et al. Low and Moderate Remifentanil Infusion Rates Do Not Alter Target-controlled Infusion Propofol Concentrations Necessary to Maintain Anesthesia as Assessed By Bispectral Index Monitoring. Anesth Analg. 2007;104(2):325-31. PubMed PMID: 17242088.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Low and moderate remifentanil infusion rates do not alter target-controlled infusion propofol concentrations necessary to maintain anesthesia as assessed by bispectral index monitoring. AU - Wang,Lars P, AU - McLoughlin,Peter, AU - Paech,Michael J, AU - Kurowski,Irina, AU - Brandon,Emma L, PY - 2007/1/24/pubmed PY - 2007/3/16/medline PY - 2007/1/24/entrez SP - 325 EP - 31 JF - Anesthesia and analgesia JO - Anesth Analg VL - 104 IS - 2 N2 - BACKGROUND: We investigated whether the EC(50) (the effective concentration that is required to achieve a response in 50% of patients) of propofol necessary to lower the Bispectral Index (BIS) value to 50 or less was reduced by coadministration of different remifentanil infusion rates. METHOD: Seventy-two adult ASA I or II patients undergoing endotracheal intubation and target-controlled infusion (TCI) propofol anesthesia were allocated to six groups by stratified randomization. Group B received remifentanil 0.1 mug x kg(-1) x min(-1), Group C 0.15 microg x kg(-1) x min(-1), Group D 0.2 microg x kg(-1) x min(-1), Group E 0.3 microg x kg(-1) x min(-1) and Group F 0.4 microg x kg(-1) x min(-1). Group A served as control and received no remifentanil. The response of the first patient to propofol TCI at 4 microg/mL determined the effect-site concentration of propofol for the next patient in the same remifentanil group (Dixon's "up-and-down" method). If BIS was >50, the next patient received more propofol, and if BIS was < or =50, the next patient received less propofol. The hemodynamic effects of the combinations were also studied. RESULTS: The EC50 varied from 2.4 to 2.9 microg/mL. No additive effect of remifentanil on the EC50 of propofol was observed. However, there was a wider variation in the response to propofol when the patients received no remifentanil. There was a decrease in heart rate in the remifentanil groups. CONCLUSION: Infusion of remifentanil did not reduce propofol requirements in the unstimulated anesthetized patient. Propofol TCI levels should not be reduced because remifentanil is coinfused. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/17242088/Low_and_moderate_remifentanil_infusion_rates_do_not_alter_target_controlled_infusion_propofol_concentrations_necessary_to_maintain_anesthesia_as_assessed_by_bispectral_index_monitoring_ L2 - https://doi.org/10.1213/01.ane.0000252966.03103.89 DB - PRIME DP - Unbound Medicine ER -