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The use of remifentanil to facilitate the insertion of the Cobra perilaryngeal airway.
Anesth Analg. 2009 May; 108(5):1505-9.A&A

Abstract

BACKGROUND

The use of remifentanil before propofol administration facilitates the insertion of the Laryngeal Mask Airway. We designed the present study to determine whether remifentanil would also create more suitable conditions for providing Cobra Perilaryngeal airway (CobraPLA) insertion when administered with propofol.

METHODS

Both remifentanil and propofol were given as effect-site target-controlled infusions. There were four groups of 25 patients each. The propofol effect-site concentration was set at 6 microg/mL in all groups. Group R1 received a target effect-site remifentanil concentration of 1 ng/mL, Group R2 received remifentanil at 2 ng/mL, Group R3 received remifentanil at 3 ng/mL, and Group R4 received remifentanil at 4 ng/mL before the induction of anesthesia with propofol. The ease of insertion of CobraPLA was graded by the following 3-point scale: Grade 1, excellent, no response to CobraPLA insertion; Grade 2, acceptable, gagging or swallowing with insertion of CobraPLA; Grade 3, poor, unable to open mouth or biting upon insertion of CobraPLA.

RESULTS

The most patients ranked as excellent for the first CobraPLA insertion (Grade 1) were found in Group R4, which was significantly higher than Groups R1 and R2 (P < 0.01), whereas no significant difference was found when compared with Group R3. The duration of apnea showed a significant dose-related increase (P < 0.01), especially between Group R2 (median 2.95 min) and R3 (median 7.9 min), but there was no significant difference between Groups R3 and R4. The incidence of hypotension in Group R4 within 1 min after insertion of CobraPLA was significantly more than for Groups R1 and R2 (P < 0.01). No significant differences could be found between the incidence of hypotension between Group R3 and the other groups. The incidence of hypertension at 1 min postinsertion was significantly more common in Groups R1 and R2 than Groups R3 and R4 (P < 0.01).

CONCLUSION

An effect-site concentration of remifentanil of 2 ng/mL provides excellent conditions for insertion of the CobraPLA on the first attempt with minimal hemodynamic perturbations and a shorter duration of apnea.

Authors+Show Affiliations

Department of Anesthesiology and Pain Medicine, College of Medicine, Hanyang University, Seoul, Korea.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

19372329

Citation

Jeon, Woo Jae, et al. "The Use of Remifentanil to Facilitate the Insertion of the Cobra Perilaryngeal Airway." Anesthesia and Analgesia, vol. 108, no. 5, 2009, pp. 1505-9.
Jeon WJ, Kim KH, Suh JK, et al. The use of remifentanil to facilitate the insertion of the Cobra perilaryngeal airway. Anesth Analg. 2009;108(5):1505-9.
Jeon, W. J., Kim, K. H., Suh, J. K., & Cho, S. Y. (2009). The use of remifentanil to facilitate the insertion of the Cobra perilaryngeal airway. Anesthesia and Analgesia, 108(5), 1505-9. https://doi.org/10.1213/ane.0b013e31819e0248
Jeon WJ, et al. The Use of Remifentanil to Facilitate the Insertion of the Cobra Perilaryngeal Airway. Anesth Analg. 2009;108(5):1505-9. PubMed PMID: 19372329.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The use of remifentanil to facilitate the insertion of the Cobra perilaryngeal airway. AU - Jeon,Woo Jae, AU - Kim,Kyoung Hun, AU - Suh,Jung Kook, AU - Cho,Sang Yun, PY - 2009/4/18/entrez PY - 2009/4/18/pubmed PY - 2009/5/1/medline SP - 1505 EP - 9 JF - Anesthesia and analgesia JO - Anesth Analg VL - 108 IS - 5 N2 - BACKGROUND: The use of remifentanil before propofol administration facilitates the insertion of the Laryngeal Mask Airway. We designed the present study to determine whether remifentanil would also create more suitable conditions for providing Cobra Perilaryngeal airway (CobraPLA) insertion when administered with propofol. METHODS: Both remifentanil and propofol were given as effect-site target-controlled infusions. There were four groups of 25 patients each. The propofol effect-site concentration was set at 6 microg/mL in all groups. Group R1 received a target effect-site remifentanil concentration of 1 ng/mL, Group R2 received remifentanil at 2 ng/mL, Group R3 received remifentanil at 3 ng/mL, and Group R4 received remifentanil at 4 ng/mL before the induction of anesthesia with propofol. The ease of insertion of CobraPLA was graded by the following 3-point scale: Grade 1, excellent, no response to CobraPLA insertion; Grade 2, acceptable, gagging or swallowing with insertion of CobraPLA; Grade 3, poor, unable to open mouth or biting upon insertion of CobraPLA. RESULTS: The most patients ranked as excellent for the first CobraPLA insertion (Grade 1) were found in Group R4, which was significantly higher than Groups R1 and R2 (P < 0.01), whereas no significant difference was found when compared with Group R3. The duration of apnea showed a significant dose-related increase (P < 0.01), especially between Group R2 (median 2.95 min) and R3 (median 7.9 min), but there was no significant difference between Groups R3 and R4. The incidence of hypotension in Group R4 within 1 min after insertion of CobraPLA was significantly more than for Groups R1 and R2 (P < 0.01). No significant differences could be found between the incidence of hypotension between Group R3 and the other groups. The incidence of hypertension at 1 min postinsertion was significantly more common in Groups R1 and R2 than Groups R3 and R4 (P < 0.01). CONCLUSION: An effect-site concentration of remifentanil of 2 ng/mL provides excellent conditions for insertion of the CobraPLA on the first attempt with minimal hemodynamic perturbations and a shorter duration of apnea. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/19372329/The_use_of_remifentanil_to_facilitate_the_insertion_of_the_Cobra_perilaryngeal_airway_ DB - PRIME DP - Unbound Medicine ER -