| What is the optimal effect-site concentration of remifentanil for minimizing the cardiovascular changes to endotracheal intubation during induction with propofol in elderly patients? |
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Yang Ju Tak, Hyun Jung Shin, Eun Seok Kim, Bon Wook Koo, Young Duck Shin, Sang Tae Kim |
1Department of Anesthesiology and Pain Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea. kimst@chungbuk.ac.kr
2Department of Emergency Medical Service, Chungju National University, Jeungpyeong, Korea. |
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| Abstract |
BACKGROUND
The addition of remifentanil during propofol TCI (target controlled infusion) attenuates the hemodynamic changes induced by endotracheal intubation. This study examined the optimal effect-site concentration of remifentanil to minimize the cardiovascular changes to endotracheal intubation in elderly patients. METHODS: Fifty ASA 1 or 2 elderly patients scheduled for elective surgery under general anesthesia were assigned randomly to one of two groups according to the effect-site concentration of remifentanil. Each group was administered 4 microgram/ml of propofol TCI with 1 ng/ml (group R1) or 3 ng/ml (group R3) of remifentanil. The heart rate (HR), systolic (SAP), mean (MAP) and diastolic arterial pressure (DAP) were measured at pre-induction, before and after endotracheal intubation.
RESULTS
After intubation, the HR, SAP, MAP and DAP increased significantly in the two groups compared with the pre-intubation values. However, the HR, SAP, MAP and DAP for group R3 were lower than group R1 for 5 min after intubation. CONCLUSIONS: In elderly patients administered 4 microg/ml of propofol TCI, we suggest that the optimal effect-site concentration of remifentanil to minimize the cardiovascular changes to endotracheal intubation is 3 ng/ml rather than 1 ng/ml. |
| Key Words:
Cardiovascular changes; Effect-site concentration; Elderly patient; Intubation; Propofol; Remifentanil |
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