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The optimal dose of remifentanil for acceptable intubating conditions during propofol induction without neuromuscular blockade.
J Clin Anesth. 2012 Aug; 24(5):392-7.JC

Abstract

STUDY OBJECTIVE

To determine the optimal remifentanil dose required to provide acceptable intubating conditions following induction of anesthesia with propofol without using neuromuscular blockade.

DESIGN

Dose-response study.

SETTING

Operating room of a university hospital.

PATIENTS

50 ASA physical status 1 men, aged between 20 and 40 years, who were scheduled for general anesthesia.

INTERVENTIONS

Intubating conditions were evaluated according to the scoring system described by Viby-Mogensen et al. Successful intubation was defined as excellent or good.

MEASUREMENTS

For induction of anesthesia, an intravenous (IV) bolus dose of propofol 2.0 mg/kg was given over 30 seconds followed by the administration of predetermined IV remifentanil over 30 seconds; intubation was performed 90 seconds after completion of the remifentanil administration. The dose of remifentanil used for each patient was determined by the response of the previously tested patients, using the modified Dixon's up-and-down method (using 0.2 μg/kg as a step size). The first patient was tested with remifentanil 1.0 μg/kg. If intubation failed, the remifentanil dose was increased by 0.2 μg/kg; if intubation was successful, the dose was decreased by 0.2 μg/kg. Mean arterial pressure (MAP), heart rate (HR), and peripheral oxygen saturation were recorded during the study period.

MAIN RESULTS

According to probit analysis, the effective dose of remifentanil in 50% (ED(50)) and 95% (ED(95)) of patients were 1.40 μg/kg and 2.40 μg/kg, respectively. Preintubation and postinduction HR and MAP values were lower than preinduction values (P < 0.001).

CONCLUSION

The optimal bolus dose of remifentanil for acceptable intubating conditions was 2.40 μg/kg (95% confidence interval, 1.90-9.0 μg/kg) in 95% of patients during induction of anesthesia with propofol 2.0 mg/kg without neuromuscular blocking agents.

Authors+Show Affiliations

Department of Anaesthesiology, Bafra State Hospital, Bafra/Samsun, Turkey.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

22748212

Citation

Demirkaya, Mustafa, et al. "The Optimal Dose of Remifentanil for Acceptable Intubating Conditions During Propofol Induction Without Neuromuscular Blockade." Journal of Clinical Anesthesia, vol. 24, no. 5, 2012, pp. 392-7.
Demirkaya M, Kelsaka E, Sarihasan B, et al. The optimal dose of remifentanil for acceptable intubating conditions during propofol induction without neuromuscular blockade. J Clin Anesth. 2012;24(5):392-7.
Demirkaya, M., Kelsaka, E., Sarihasan, B., Bek, Y., & Üstün, E. (2012). The optimal dose of remifentanil for acceptable intubating conditions during propofol induction without neuromuscular blockade. Journal of Clinical Anesthesia, 24(5), 392-7. https://doi.org/10.1016/j.jclinane.2011.11.006
Demirkaya M, et al. The Optimal Dose of Remifentanil for Acceptable Intubating Conditions During Propofol Induction Without Neuromuscular Blockade. J Clin Anesth. 2012;24(5):392-7. PubMed PMID: 22748212.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The optimal dose of remifentanil for acceptable intubating conditions during propofol induction without neuromuscular blockade. AU - Demirkaya,Mustafa, AU - Kelsaka,Ebru, AU - Sarihasan,Binnur, AU - Bek,Yüksel, AU - Üstün,Emre, PY - 2011/03/23/received PY - 2011/11/15/revised PY - 2011/11/16/accepted PY - 2012/7/4/entrez PY - 2012/7/4/pubmed PY - 2012/10/24/medline SP - 392 EP - 7 JF - Journal of clinical anesthesia JO - J Clin Anesth VL - 24 IS - 5 N2 - STUDY OBJECTIVE: To determine the optimal remifentanil dose required to provide acceptable intubating conditions following induction of anesthesia with propofol without using neuromuscular blockade. DESIGN: Dose-response study. SETTING: Operating room of a university hospital. PATIENTS: 50 ASA physical status 1 men, aged between 20 and 40 years, who were scheduled for general anesthesia. INTERVENTIONS: Intubating conditions were evaluated according to the scoring system described by Viby-Mogensen et al. Successful intubation was defined as excellent or good. MEASUREMENTS: For induction of anesthesia, an intravenous (IV) bolus dose of propofol 2.0 mg/kg was given over 30 seconds followed by the administration of predetermined IV remifentanil over 30 seconds; intubation was performed 90 seconds after completion of the remifentanil administration. The dose of remifentanil used for each patient was determined by the response of the previously tested patients, using the modified Dixon's up-and-down method (using 0.2 μg/kg as a step size). The first patient was tested with remifentanil 1.0 μg/kg. If intubation failed, the remifentanil dose was increased by 0.2 μg/kg; if intubation was successful, the dose was decreased by 0.2 μg/kg. Mean arterial pressure (MAP), heart rate (HR), and peripheral oxygen saturation were recorded during the study period. MAIN RESULTS: According to probit analysis, the effective dose of remifentanil in 50% (ED(50)) and 95% (ED(95)) of patients were 1.40 μg/kg and 2.40 μg/kg, respectively. Preintubation and postinduction HR and MAP values were lower than preinduction values (P < 0.001). CONCLUSION: The optimal bolus dose of remifentanil for acceptable intubating conditions was 2.40 μg/kg (95% confidence interval, 1.90-9.0 μg/kg) in 95% of patients during induction of anesthesia with propofol 2.0 mg/kg without neuromuscular blocking agents. SN - 1873-4529 UR - https://www.unboundmedicine.com/medline/citation/22748212/The_optimal_dose_of_remifentanil_for_acceptable_intubating_conditions_during_propofol_induction_without_neuromuscular_blockade_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0952-8180(12)00184-5 DB - PRIME DP - Unbound Medicine ER -