Effect-site concentration of remifentanil to blunt the hemodynamic changes during rapid sequence intubation

Lee, Young Min; Lee, Jeoung Hyuk; In, Junyong; Lee, Younsuk; Yoon, Myung Ha; Kim, Woong Mo

Clinical Research

Anesthetic Pharmacology

Anesthesia and Pain Medicine 2010;5(4):295-300.
Published online October 31, 2010.

Effect-site concentration of remifentanil to blunt the hemodynamic changes during rapid sequence intubation

Young Min Lee, Jeoung Hyuk Lee, Junyong In, Younsuk Lee, Myung Ha Yoon, Woong Mo Kim

¹Department of Anesthesiology and Pain Medicine, Ilsan Hospital, College of Medicine, Dongguk University, Ilsan, Korea.
²Department of Anesthesiology and Pain Medicine, Chonnam National University, Medical School, Gwangju, Korea.
³Department of Anesthesiology and Pain Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea. jjajangw@naver.com

Abstract

BACKGROUND
This study was undertaken to evaluate the effect-site concentration of remifentanil to blunt the hemodynamic changes during rapid sequence intubation.
METHODS
Eighty patients were enrolled and divided into four groups being assigned with different effect-site concentrations (Ce)of remifentanil of 0, 2, 3, or 4 ng/ml. Patients arrived at the operating room without premedication and their baseline vital signs were recorded. With preoxygenation of 100% O2, remifentanil was infused by target controlled infusion according to patient group. After achievement of a stable level of Ce, propofol 2 mg/kg and rocuronium 1.2 mg/kg were injected and the trachea was intubated one minute later. Hemodynamic changes were recorded at 1, 2, and 3 min after remifentanil infusion, immediately before and after endotracheal intubation, and 1 and 2 min after endotracheal intubation.
RESULTS
The 50% effective Ce of remifentanil was 1.4 ng/ml (95% confidence interval, CI: 0.9-1.8) to blunt the increase of mean blood pressure and was 2.4 ng/ml (95% CI: 1.6-3.1) to blunt the increase of heart rate. The 50% Ce for the decrease of mean blood pressure was 2.8 ng/ml (95% CI: 2.2-3.4).
CONCLUSIONS
During the rapid sequence intubation, the 50% effective effect site concentration of remifentanil to prevent hemodynamic changes is between 2.4 and 2.8 ng/ml.

Key Words: Heart rate, Mean blood pressure, Rapid sequence intubation, Remifentanil