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Effect of nitrous oxide on desflurane MACBAR at two target-controlled concentrations of remifentanil.
Minerva Anestesiol. 2008 May; 74(5):165-72.MA

Abstract

BACKGROUND

The aim of this prospective, randomized, double-blind study was to determine the effect of nitrous oxide on the desflurane requirement for blunting sympathetic response following surgical incision (MACBAR) when desflurane was combined with two different target-controlled concentrations of remifentanil (1 and 3 ng/mL).

METHODS

A total of 103 patients, aged 20-50 years, ASA physical status I, scheduled to undergo general anesthesia for elective abdominal surgery, were randomly allocated to receive anesthesia with desflurane alone (Group A, n = 53), or with the addition of 60% nitrous oxide (Group N, n = 50). Patients of both groups were further assigned to receive a target-controlled plasma concentration of 1 ng/mL (Group A1, n = 27; Group N1, n = 26) or 3 ng/mL remifentanil (Group A3, n = 26, Group N3, n = 24). Sympathetic responses to surgical incision were determined after a 20 min period of constant end-tidal desflurane and target-controlled remifentanil concentrations. Predetermined end-tidal desflurane concentrations and the MACBAR for each group were determined using an up-and-down sequential allocation technique.

RESULTS

A total of 98 patients completed the study. The MACBAR of desflurane was 5.2% (95% confidence interval [CI95: 4.9-5.5%]) in Group A1 and 2.7% (CI95: 2.6-2.8%) in Group N1 (P<0.001), while in Groups A3 and N3 the MACBAR of desflurane was 2.2% (CI95:2-2.4%) and 2% (CI95:1.9-2.2%), respectively (P<0.01). When considering a minimum anesthetic concentration (MAC) value with a contribution of 60% nitrous oxide (0.55 MAC) in this population, the combined MACBAR values (expressed as multiples of the MAC) were 1.9 MAC for group A1, 1 MAC for group N1, 0.8 MAC for group A3, and 0.7 MAC for group N3.

CONCLUSION

The addition of 60% nitrous oxide reduces the MACBAR of desflurane by 52% when using a remifentanil concentration of 1 ng/mL, and reduces the MACBAR by 10% when using a remifentanil concentration of 3 ng/mL.

Authors+Show Affiliations

Department of Anesthesiology, IRCCS H. San Raffaele, Vita-Salute University of Milan, Milan, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18414359

Citation

Dedola, E, et al. "Effect of Nitrous Oxide On Desflurane MACBAR at Two Target-controlled Concentrations of Remifentanil." Minerva Anestesiologica, vol. 74, no. 5, 2008, pp. 165-72.
Dedola E, Albertin A, Poli D, et al. Effect of nitrous oxide on desflurane MACBAR at two target-controlled concentrations of remifentanil. Minerva Anestesiol. 2008;74(5):165-72.
Dedola, E., Albertin, A., Poli, D., La Colla, L., Gandolfi, A., Martani, C., & Torri, G. (2008). Effect of nitrous oxide on desflurane MACBAR at two target-controlled concentrations of remifentanil. Minerva Anestesiologica, 74(5), 165-72.
Dedola E, et al. Effect of Nitrous Oxide On Desflurane MACBAR at Two Target-controlled Concentrations of Remifentanil. Minerva Anestesiol. 2008;74(5):165-72. PubMed PMID: 18414359.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of nitrous oxide on desflurane MACBAR at two target-controlled concentrations of remifentanil. AU - Dedola,E, AU - Albertin,A, AU - Poli,D, AU - La Colla,L, AU - Gandolfi,A, AU - Martani,C, AU - Torri,G, PY - 2008/4/17/pubmed PY - 2008/8/20/medline PY - 2008/4/17/entrez SP - 165 EP - 72 JF - Minerva anestesiologica JO - Minerva Anestesiol VL - 74 IS - 5 N2 - BACKGROUND: The aim of this prospective, randomized, double-blind study was to determine the effect of nitrous oxide on the desflurane requirement for blunting sympathetic response following surgical incision (MACBAR) when desflurane was combined with two different target-controlled concentrations of remifentanil (1 and 3 ng/mL). METHODS: A total of 103 patients, aged 20-50 years, ASA physical status I, scheduled to undergo general anesthesia for elective abdominal surgery, were randomly allocated to receive anesthesia with desflurane alone (Group A, n = 53), or with the addition of 60% nitrous oxide (Group N, n = 50). Patients of both groups were further assigned to receive a target-controlled plasma concentration of 1 ng/mL (Group A1, n = 27; Group N1, n = 26) or 3 ng/mL remifentanil (Group A3, n = 26, Group N3, n = 24). Sympathetic responses to surgical incision were determined after a 20 min period of constant end-tidal desflurane and target-controlled remifentanil concentrations. Predetermined end-tidal desflurane concentrations and the MACBAR for each group were determined using an up-and-down sequential allocation technique. RESULTS: A total of 98 patients completed the study. The MACBAR of desflurane was 5.2% (95% confidence interval [CI95: 4.9-5.5%]) in Group A1 and 2.7% (CI95: 2.6-2.8%) in Group N1 (P<0.001), while in Groups A3 and N3 the MACBAR of desflurane was 2.2% (CI95:2-2.4%) and 2% (CI95:1.9-2.2%), respectively (P<0.01). When considering a minimum anesthetic concentration (MAC) value with a contribution of 60% nitrous oxide (0.55 MAC) in this population, the combined MACBAR values (expressed as multiples of the MAC) were 1.9 MAC for group A1, 1 MAC for group N1, 0.8 MAC for group A3, and 0.7 MAC for group N3. CONCLUSION: The addition of 60% nitrous oxide reduces the MACBAR of desflurane by 52% when using a remifentanil concentration of 1 ng/mL, and reduces the MACBAR by 10% when using a remifentanil concentration of 3 ng/mL. SN - 1827-1596 UR - https://www.unboundmedicine.com/medline/citation/18414359/Effect_of_nitrous_oxide_on_desflurane_MACBAR_at_two_target_controlled_concentrations_of_remifentanil_ L2 - http://www.minervamedica.it/index2.t?show=R02Y2008N05A0165 DB - PRIME DP - Unbound Medicine ER -