| What is an Optimal Effect Site Concentration of Remifentanil for Minimizing the Hemodynamic Change to Endotracheal Intubation using Light Wand? |
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Jeoung Hyuk Lee, Woo Jae Jeon, Jae Hang Shim, Sang Yoon Cho, Jong Hoon Yeom, Woo Jong Shin, Kyoung Hun Kim |
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Department of Anesthesiology and Pain Medicine, College of Medicine, Hanyang University, Seoul, Korea. goldnan@hanyang.ac.kr |
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| Abstract |
BACKGROUND
In the previous studies, remifentanil reduces the hemodynamic change induced by endotracheal intubation.
We studied the optimal effect site concentration of remifentanil for endotracheal intubation using light wand.
METHODS
Sixty ASA 1 or 2 patients scheduled for elective surgery under general anesthesia were classified in three groups according to the TCI (target controlled infusion) dose of remifentanil. Each group was administered 4microgram/ml of propofol TCI, rocuronium, with 2 ng/ml (group 1), 4 ng/ml (group 2), 6 ng/ml (group 3) of remifentanil TCI. Blood pressure, heart rate and bispectral index score were measured before induction, 3 minutes after remifentanil and propofol TCI, after endotracheal intubation using light wand, and 3 minutes after endotracheal intubation. Statistical analysis was done for comparison of time and dose dependant change among the groups.
RESULTS
After endotrachal intubation, blood pressure and heart rate were significantly increased in group 1, and decreased in group 2 and 3. 3 minute after endotracheal intubation, heart rate significantly decreased in group 3, but there were no changes in group 2.
CONCLUSIONS
The spontaneous BRS was decreased during ketamine induction of general anesthesia. These results suggest that anesthesia induction with ketamine impairs baroreflex control of heart rate, which may provoke hemodynamic instability. |
| Key Words:
intubation; light wand; propofol; remifentanil; target controlled infusion |
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