Korean J Anesthesiol. 2011 Jan;60(1):12-8. doi: 10.4097/kjae.2011.60.1.12. Epub 2011 Jan 28.

The target concentration of remifentanil to suppress the hemodynamic response to endotracheal intubation during inhalational induction with desflurane.

Korean journal of anesthesiology

Jiwon Lee, Chul-Woo Jung

PMID: 21359075 PMCID: PMC3040425 DOI: 10.4097/kjae.2011.60.1.12

Abstract

BACKGROUND: Anesthesia induction with desflurane is troublesome because of the frequent sympathetic hyperactivity during desflurane administration. We thought that a low concentration of desflurane combined with a target-controlled infusion (TCI) of remifentanil would eliminate the desflurane-related complications and provide hemodynamic stability during desflurane induction. An up-and-down study was planned to find the target effect-site concentration of remifentanil to block the hemodynamic response to endotracheal intubation, the highest level of stimulus, during anesthesia induction with administering desflurane at 1 MAC.

METHODS: Remifentanil TCI was initiated before desflurane administration. When the preset target was achieved, spontaneous inhalation of desflurane 1 MAC was performed until the patients became unconscious. Laryngoscopic tracheal intubation was facilitated with rocuronium injection. The starting concentration of remifentanil and the test space were 5 and 1 ng/ml, respectively. The criteria for up-and-down was a 20% increase of the mean arterial pressure or heart rate after intubation. The median effective concentration (EC(50)) of remifentanil was calculated from 6 independent pairs. The complications related with remifentanil and desflurane were assessed during the study.

RESULTS: We studied 20 patients using 2-5 ng/ml of the effect-site concentrations of remifentanil. The EC(50) of remifentanil was 3.7 ng/ml. Loss of consciousness was achieved at 125 ± 22 s after desflurane inhalation and this was irrespective of the combined remifentanil concentrations. Any remifentanil-related complication was not observed. Transient cough was seen in one patient who received 2 ng/ml of remifentanil.

CONCLUSIONS: We demonstrated that uncomplicated induction with desflurane was possible by the use of target-controlled remifentanil. The EC(50) of remifentanil to block the hemodynamic response to tracheal intubation was 3.7 ng/ml during inhalational induction with 1 MAC desflurane.

Keywords: Anesthesia; Desflurane; Inhalation; Intravenous; Remifentanil

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