Escobar-Escobar NF, Olvera-Morales G, Martínez-Segura RT, Silva-Jiménez A

Language: Spanish
References: 18
Page: 263-270
PDF size: 119.94 Kb.

ABSTRACT

Objective: To demonstrate the optimal dose of remifentanyl between 5, 7 and 10 ng/mL during laryngoscopy in ASA I and ASA II patients. To asses the hemodynamic response that occurs during laryngoscopy and intubation when using a remifentanyl dose of 5 to 10 ng/mL. To determine the optimal conditions for endotracheal intubation with the administration of a remifentanyl dose of 5 to 10 ng/mL by the Helbo Hansen’s scale. Materials and methods: 51 patients being under general anesthesia for elective ASA I, and ASA II surgeries, ranging between 18 and 65 years old, randomly divided into 3 groups were included in this study; Remifentanyl dosages of 5 ng/mL, 7 ng/mL and 10 ng/mL; the following measurements were performed in preoperative, at surgery admission, 1, 2 and 5 minutes from the intubation of the variables: blood pressure, heart rate, oxygen saturation and bispectral index. The patients were medicated with midazolam, induced with remifentanyl at the established doses according to the group they belonged to (1, 1.4 and 2 µg/kg), cisatracurio (150 µg/kg) and propofol (2, 1.5 and 1 mg/kg) respectively. Results: There was a significant difference (p ‹ 0.05) in heart rate and blood pressure during the first minute at the laryngoscopy and in the group of remifentanyl at doses of 7 and 10 ng/mL. In addition to this, the conditions for the intubation, measured through the Helbo-Hansen’s scale, from the remifentanyl Group at 10 ng/mL were more favorable than in the other groups. Conclusion: The study concludes that a remifentanyl dose of 10 ng/mL in the therapeutic window, combined with propofol at a dose of 1 mg/kg, provides excellent intubation conditions and increased hemodynamic stability during laryngoscopy and endotracheal intubation.

REFERENCES

1. Toshiya SM, Zenchichiro WM, Tetsuo IM, Atsuhiro SM. Predicting difficult intubation in apparently normal patients. Anesthesiology 1992;5:429-437.

2. Blair JM, Hill DA, Wilson CM, Fee JP. Assessment of tracheal intubation in children after induction with propofol and different doses of remifentanyl. Anaesthesia 2004;59:27-33.

3. Klemola UM, Mennander S, Saarnivaara L. Tracheal intubation without the use of muscle relaxants: remifentanyl or alfentanyl in combination with propofol. Acta Anaesthesiologica Scandinavica 2000;44:465-469.

4. Troy AM, Hutchinson RC, Easy WR, Kenny GN. Tracheal intubating conditions using propofol and remifentanyl target-controlled infusions. Anaesthesia 2002;57:1195-1212.

5. Trabold F, Casetta M, Durenteau J, Albaladejo P, Mazoit JX, Samii K, Benhamou D, Sitbon P. Propofol and remifentanyl for intubation without muscle relaxant: the effect of the order of injection. Acta Anesthesiologica Scandinavica 2004;48:35-39.

6. Batra YK, Qattan AR, Qureshi MI, Kuriakose D, Migahed A. Assessment of tracheal intubating conditions in children using remifentanyl and propofol without muscle relaxant. Pediatric Anesthesia 2004;14:452-456.

7. Miller RD. Anestesia, Editorial Elsevier. Madrid España, Sexta edición 2005:281-375.

8. Howie MB, Michelsen L, Hug C, Porembka DT, Jopling MW, Warren SM, Shaikh S. Comparison of three remifentanyl dose- finding regimens for coronary artery surgery. Journal of Cardiothoracic and Vascular Anesthesia 2003;1:51-59.

9. Hughes M, Glass P, Jacobs J. Context–sensitive half time in multicompartment pharmacokinetic models for intravenous anesthetic drugs. Anesthesiology 1992;76:334-341.

10. Egan. Remifentanyl: Pharmacokinetics and pharmacodynamics. Clinical Pharmacokinetics 1995;29:80-94.

11. Wadbrook PS. Advances in airway pharmacology: Emerging trends and evolving controversy. Emergency Medicine Clinics of North America 2000;18:4.

12. Patel SS, Spencer C. Remifentanyl. Drugs 1996;52:417-424.

13. Keles GT, Yentur A, Cavus Z, Sakarya M. Assessment of neuromuscular and hemodynamic effects of cisatracurium and vecuronium under sevofluorano – remifentanyl anaesthesia in elderly patients. European Journal of Aneaesthesiology 2004;21:877-881.

14. Glass P, Hardman D, Kamiyama Y, Quill T, Marton G, Grosse M, Hermann D. Preliminary pharmacokinetics and pharmacodynamics of an ultra short acting opioid: Remifentanyl (GI87084B). Anesthesia, Analgesia 1993;77:1031-1040.

15. Ferreira DA, Nunes CS, Antunes LM, Santos IA, Lobo F, Casal M. The effect of a remifentanyl bolus on the bispectral index of the EEG (BIS) in anaesthetized patients independently from intubation and surgical stimuli. European Journal of Anesthesiology 2006;23:305-310.

16. Kern K, Xie G, White JL, Egan D. Opioid–hypnotic synergy: A response surface analysis of propofol–remifentanyl pharmacodynamic interaction in volunteers. Anesthesiology 2004;100:1373-1381.

17. Mertens EMJ, Engbers AOF, Bovill BJ. Propofol reduces perioperative remifentanyl requirements in a synergistic manner. Anesthesiology 2003;99:347-359.

18. Bouillon TW, Radulescu L, Andresen C, Shafer TJ, Shafer CC, Shafer SL. Pharmacodynamic interaction between Propofol and remifentanyl regarding hypnosis, tolerance of laryngoscopy, Bispectral index and electroencephalographic approximate entropy. Anesthesiology 2004;100:1353-1372.