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Effect of sex differences in remifentanil requirements for inhibiting the response to a CO2 pneumoperitoneum during propofol anesthesia: an up-and-down sequential allocation trial.
BMC Anesthesiol. 2020 02 03; 20(1):35.BA

Abstract

BACKGROUND

A CO2 pneumoperitoneum during a laparoscopic procedure causes violent hemodynamic changes. However, the remifentanil required to inhibit the cardiovascular response to a CO2 pneumoperitoneum combined with propofol remains unknown. Moreover, the sex of the patient may influence the response to opioids, which can affect this requirement. The main objective of this study was to compare the required median effective concentration (EC50) of remifentanil for inhibiting the cardiovascular response to a CO2 pneumoperitoneum between female and male patients during propofol anesthesia.

METHODS

The current study is an up-and-down sequential allocation trial. Forty-six patients with American Society of Anesthesiologists physical status I or II, a body mass index 18 to 30 kg/m2, aged 20 to 60 years, and scheduled for laparoscopic surgery were enrolled. Induction of anesthesia was performed by target-controlled infusion. The effective effect-site concentration (Ce) of propofol was 4 μg/ml. The Ce of remifentanil was initially 4 ng/ml and then adjusted to a predetermined level after I-gel laryngeal mask airway insertion. The Ce of remifentanil for each patient was determined by the response of the previous patient using the modified Dixon "up-and-down" method. The first patient received remifentanil at 5.0 ng/ml Ce, and the step size between patients was 0.5 ng/ml.

RESULTS

Patients characteristics including age, body mass index, American Society of Anesthesiologists physical status, type of surgery and surgery duration, were comparable between male and female patients. The EC50 of remifentanil required to inhibit the response to a CO2 pneumoperitoneum based on the Dixon "up-and-down" method in women (4.17 ± 0.38 ng/ml) was significantly lower than that in men (5.00 ± 0.52 ng/ml) during propofol anesthesia (P = 0.01).

CONCLUSIONS

The EC50 of remifentanil required to inhibit the response to a CO2 pneumoperitoneum was lower in women than in men during propofol anesthesia.

TRIAL REGISTRATION

The study was registered at http://www.chictr.org.cn (ChiCTR-IOR-17011906, 8th, July, 2017).

Authors+Show Affiliations

Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230036, China.Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230031, China.Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230036, China.Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230036, China.Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230036, China.Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230036, China.Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230036, China.Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230036, China. huamuzi1999@163.com.

Pub Type(s)

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

Language

eng

PubMed ID

32013877

Citation

Yang, Chengwei, et al. "Effect of Sex Differences in Remifentanil Requirements for Inhibiting the Response to a CO2 Pneumoperitoneum During Propofol Anesthesia: an Up-and-down Sequential Allocation Trial." BMC Anesthesiology, vol. 20, no. 1, 2020, p. 35.
Yang C, Feng Y, Wang S, et al. Effect of sex differences in remifentanil requirements for inhibiting the response to a CO2 pneumoperitoneum during propofol anesthesia: an up-and-down sequential allocation trial. BMC Anesthesiol. 2020;20(1):35.
Yang, C., Feng, Y., Wang, S., Han, M., Wang, S., Kang, F., Huang, X., & Li, J. (2020). Effect of sex differences in remifentanil requirements for inhibiting the response to a CO2 pneumoperitoneum during propofol anesthesia: an up-and-down sequential allocation trial. BMC Anesthesiology, 20(1), 35. https://doi.org/10.1186/s12871-020-0951-z
Yang C, et al. Effect of Sex Differences in Remifentanil Requirements for Inhibiting the Response to a CO2 Pneumoperitoneum During Propofol Anesthesia: an Up-and-down Sequential Allocation Trial. BMC Anesthesiol. 2020 02 3;20(1):35. PubMed PMID: 32013877.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of sex differences in remifentanil requirements for inhibiting the response to a CO2 pneumoperitoneum during propofol anesthesia: an up-and-down sequential allocation trial. AU - Yang,Chengwei, AU - Feng,Yuanyuan, AU - Wang,Sheng, AU - Han,Mingming, AU - Wang,Song, AU - Kang,Fang, AU - Huang,Xiang, AU - Li,Juan, Y1 - 2020/02/03/ PY - 2019/11/24/received PY - 2020/01/23/accepted PY - 2020/2/5/entrez PY - 2020/2/6/pubmed PY - 2021/1/26/medline KW - Anesthesia KW - Pharmacology KW - Pneumoperitoneum KW - Remifentanil SP - 35 EP - 35 JF - BMC anesthesiology JO - BMC Anesthesiol VL - 20 IS - 1 N2 - BACKGROUND: A CO2 pneumoperitoneum during a laparoscopic procedure causes violent hemodynamic changes. However, the remifentanil required to inhibit the cardiovascular response to a CO2 pneumoperitoneum combined with propofol remains unknown. Moreover, the sex of the patient may influence the response to opioids, which can affect this requirement. The main objective of this study was to compare the required median effective concentration (EC50) of remifentanil for inhibiting the cardiovascular response to a CO2 pneumoperitoneum between female and male patients during propofol anesthesia. METHODS: The current study is an up-and-down sequential allocation trial. Forty-six patients with American Society of Anesthesiologists physical status I or II, a body mass index 18 to 30 kg/m2, aged 20 to 60 years, and scheduled for laparoscopic surgery were enrolled. Induction of anesthesia was performed by target-controlled infusion. The effective effect-site concentration (Ce) of propofol was 4 μg/ml. The Ce of remifentanil was initially 4 ng/ml and then adjusted to a predetermined level after I-gel laryngeal mask airway insertion. The Ce of remifentanil for each patient was determined by the response of the previous patient using the modified Dixon "up-and-down" method. The first patient received remifentanil at 5.0 ng/ml Ce, and the step size between patients was 0.5 ng/ml. RESULTS: Patients characteristics including age, body mass index, American Society of Anesthesiologists physical status, type of surgery and surgery duration, were comparable between male and female patients. The EC50 of remifentanil required to inhibit the response to a CO2 pneumoperitoneum based on the Dixon "up-and-down" method in women (4.17 ± 0.38 ng/ml) was significantly lower than that in men (5.00 ± 0.52 ng/ml) during propofol anesthesia (P = 0.01). CONCLUSIONS: The EC50 of remifentanil required to inhibit the response to a CO2 pneumoperitoneum was lower in women than in men during propofol anesthesia. TRIAL REGISTRATION: The study was registered at http://www.chictr.org.cn (ChiCTR-IOR-17011906, 8th, July, 2017). SN - 1471-2253 UR - https://www.unboundmedicine.com/medline/citation/32013877/Effect_of_sex_differences_in_remifentanil_requirements_for_inhibiting_the_response_to_a_CO2_pneumoperitoneum_during_propofol_anesthesia:_an_up_and_down_sequential_allocation_trial_ L2 - https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-020-0951-z DB - PRIME DP - Unbound Medicine ER -