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Predicted EC₅₀ and EC₉₅ of Remifentanil for Smooth Removal of a Laryngeal Mask Airway Under Propofol Anesthesia.
Yonsei Med J. 2015 Jul; 56(4):1128-33.YM

Abstract

PURPOSE

The purpose of this study was to determine the effect-site concentration (Ce) of remifentanil in 50% of patients (EC₅₀) and 95% of patients (EC₉₅) for smooth laryngeal mask airway (LMA) removal in adults under propofol and remifentanil anesthesia.

MATERIALS AND METHODS

Twenty-five patients of ASA physical status I-II and ages 18-60 years who were to undergo minor gynecological or orthopedic surgery were assessed in this study. Anesthesia was induced and maintained with propofol and remifentanil target-controlled infusion (TCI). Remifentanil was maintained at a predetermined Ce during the emergence period. The modified Dixon's up-and-down method was used to determine the remifentanil concentration, starting from 1.0 ng/mL (step size of 0.2 ng/mL). Successful removal of the LMA was regarded as absence of coughing/gagging, clenched teeth, gross purposeful movements, breath holding, laryngospasm, or desaturation to SpO₂<90%.

RESULTS

The mean±SD Ce of remifentanil for smooth LMA removal after propofol anesthesia was 0.83±0.16 ng/mL. Using isotonic regression with a bootstrapping approach, the estimated EC₅₀ and EC₉₅ of remifentanil Ce were 0.91 ng/mL [95% confidence interval (CI), 0.77-1.07 ng/mL] and 1.35 ng/mL (95% CI, 1.16-1.38 ng/mL), respectively.

CONCLUSION

Our results showed that remifentanil TCI at an established Ce is a reliable technique for achieving safe and smooth emergence without coughing, laryngospasm, or other airway reflexes.

Authors+Show Affiliations

Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea.Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, Incheon, Korea.Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, Incheon, Korea.Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea.Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea. kjyeop@ajou.ac.kr.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26069139

Citation

Yoo, Ji Young, et al. "Predicted EC₅₀ and EC₉₅ of Remifentanil for Smooth Removal of a Laryngeal Mask Airway Under Propofol Anesthesia." Yonsei Medical Journal, vol. 56, no. 4, 2015, pp. 1128-33.
Yoo JY, Kwak HJ, Lee KC, et al. Predicted EC₅₀ and EC₉₅ of Remifentanil for Smooth Removal of a Laryngeal Mask Airway Under Propofol Anesthesia. Yonsei Med J. 2015;56(4):1128-33.
Yoo, J. Y., Kwak, H. J., Lee, K. C., Kim, G. W., & Kim, J. Y. (2015). Predicted EC₅₀ and EC₉₅ of Remifentanil for Smooth Removal of a Laryngeal Mask Airway Under Propofol Anesthesia. Yonsei Medical Journal, 56(4), 1128-33. https://doi.org/10.3349/ymj.2015.56.4.1128
Yoo JY, et al. Predicted EC₅₀ and EC₉₅ of Remifentanil for Smooth Removal of a Laryngeal Mask Airway Under Propofol Anesthesia. Yonsei Med J. 2015;56(4):1128-33. PubMed PMID: 26069139.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predicted EC₅₀ and EC₉₅ of Remifentanil for Smooth Removal of a Laryngeal Mask Airway Under Propofol Anesthesia. AU - Yoo,Ji Young, AU - Kwak,Hyun Jeong, AU - Lee,Kyung Cheon, AU - Kim,Go Wun, AU - Kim,Jong Yeop, PY - 2015/6/13/entrez PY - 2015/6/13/pubmed PY - 2015/11/17/medline KW - Laryngeal mask airway KW - device removal KW - effect-site concentration KW - general anesthesia KW - remifentanil KW - target-controlled infusion SP - 1128 EP - 33 JF - Yonsei medical journal JO - Yonsei Med J VL - 56 IS - 4 N2 - PURPOSE: The purpose of this study was to determine the effect-site concentration (Ce) of remifentanil in 50% of patients (EC₅₀) and 95% of patients (EC₉₅) for smooth laryngeal mask airway (LMA) removal in adults under propofol and remifentanil anesthesia. MATERIALS AND METHODS: Twenty-five patients of ASA physical status I-II and ages 18-60 years who were to undergo minor gynecological or orthopedic surgery were assessed in this study. Anesthesia was induced and maintained with propofol and remifentanil target-controlled infusion (TCI). Remifentanil was maintained at a predetermined Ce during the emergence period. The modified Dixon's up-and-down method was used to determine the remifentanil concentration, starting from 1.0 ng/mL (step size of 0.2 ng/mL). Successful removal of the LMA was regarded as absence of coughing/gagging, clenched teeth, gross purposeful movements, breath holding, laryngospasm, or desaturation to SpO₂<90%. RESULTS: The mean±SD Ce of remifentanil for smooth LMA removal after propofol anesthesia was 0.83±0.16 ng/mL. Using isotonic regression with a bootstrapping approach, the estimated EC₅₀ and EC₉₅ of remifentanil Ce were 0.91 ng/mL [95% confidence interval (CI), 0.77-1.07 ng/mL] and 1.35 ng/mL (95% CI, 1.16-1.38 ng/mL), respectively. CONCLUSION: Our results showed that remifentanil TCI at an established Ce is a reliable technique for achieving safe and smooth emergence without coughing, laryngospasm, or other airway reflexes. SN - 1976-2437 UR - https://www.unboundmedicine.com/medline/citation/26069139/Predicted_EC₅₀_and_EC₉₅_of_Remifentanil_for_Smooth_Removal_of_a_Laryngeal_Mask_Airway_Under_Propofol_Anesthesia_ L2 - https://www.eymj.org/DOIx.php?id=10.3349/ymj.2015.56.4.1128 DB - PRIME DP - Unbound Medicine ER -