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KMID : 0356920080540010037
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Korean Journal of Anesthesiology
2008 Volume.54 No. 1 p.37 ~ p.42
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Adequate Combination of Target Effect-site Concentration of Propofol and Remifentanil for Tracheal Intubation
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Han Jong-In
Lee Hee-Seung
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Abstract
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Background: We wanted to determine an adequate combination of target effect-site concentrations of remifentanil and propofol during anesthetic induction with target controlled infusion (TCI).We also determined whether increasing remifentanil concentrations might reduce propofol consumption at loss of consciousness (LOC).
Methods: Sixty ASA 1 or 2 patients were randomly allocated according to the target effect-site concentration of remifentanil and propofol (R7P3: remifentanil 7 ng/ml + propofol 3?g/ml, R5P4: remifentanil 5 ng/ml + propofol 4?g/ml, R3P5: remifentanil 3 ng/ml + propofol 5?g/ml). After the target effect-site concentration of remifentanil had been reached, the TCI of propofol was started. The effect-site concentration of propofol at LOC was recorded. When the target effect-site concentration of propofol was reached, 0.6 mg/kg of rocuronium was administered. Tracheal intubation was performed after 2 minutes. The noninvasive blood pressure, heart rate (HR), bispectral index (BIS), and infused dose of remifentanil and propofol were recorded.
Results: R3P5 groupd showed a significant increase in mean blood pressure after intubation (104 ± 31.9 mmHg, P ＜ 0.05) compared to R7P3 and R5P4. BIS at the time when propofol reached its target effect-site concentration was significantly higher in the R7P3 group (71.6 ± 9.9, P ＜ 0.05 compared to R5P4 and R3P5). There was a significant relationship between the effect-site concentration of remifentanil and propofol at LOC (Y = 2.032 ? 0.351X, R2 = 0.551, P ＜ 0.0001).
Conclusion: The R5P4 target effect-site concentrations are adequate dosing combinations during TCI induction based on hemodynamic responses and BIS values. (Korean J Anesthesiol 2008; 54: 37∼42)
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KEYWORD
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bispectral index, effect-site concentration, hemodynamic, propofol, remifentanil, target-controlled infusion
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