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Daquin A, Marliere F, Raichi A, Annoot A, Journaux C, Lebuffe G, Villers A, Marcq G. Sedation vs. general anesthesia in stone ureteroscopy: Comparison of efficacy and safety, a post COVID-19 report. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102658. [PMID: 38821384 DOI: 10.1016/j.fjurol.2024.102658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/08/2024] [Accepted: 05/26/2024] [Indexed: 06/02/2024]
Abstract
INTRODUCTION Ureterorenoscopy (URS) for ureteral or renal stones is traditionally performed under general anesthesia (GA). Sedation is an alternative to GA, allowing control of the level of consciousness, spontaneous ventilation, and faster recovery. Our aim was to compare sedation and GA for patients undergoing ureterorenoscopy. Endpoints were stone-free rate (SFR) and complication rates. METHOD Monocentric comparative retrospective study including all consecutive ureterorenoscopies for ureteral or renal stone. The inclusion period was dichotomized in two 6-months periods due to the COVID-19 pandemic: from January 1 to July 1, 2019 (URS under GA) and from January 1 to July 1, 2021 (URS under GA or sedation). Stone-free (SF) status was defined as the absence of stone or fragment>4mm after the first ureterorenoscopy. Complication rates were assessed according to the Satava (perioperative complications) and Clavien-Dindo (postoperative complications) classifications. Statistical analysis was performed by Chi-square test. RESULTS A total of 185 patients were included for a total of 206 ureterorenoscopies; 82 underwent ureterorenoscopy under GA and 103 under sedation. The median stone size was 10 [7-16] mm. In all, 150 (81%) patients had at least one intrarenal stone. The SFR was similar between the two groups (67% GA group, 69% sedation group, P=0.912). In the sedation group, the mean SFR in ureter was 83.7% vs. 92.5% in the GA group. In renal cavities, the mean SFR was 46.4% in the sedation group vs. 42.5% in the GA group. Satava grade I, IIa, and IIb complications were 5 (6%), 5 (6%), and 1 (1%) in the GA group and 6 (6%), 1 (1%), and 3 (3%) in the sedation group, respectively (P=0.214). The grade I, II, III, and IV Clavien complications were 6 (7%), 3 (4%), 0 (0%), and 2 (2%) in the GA group and 6 (6%), 4 (4%), 1 (1%), and 4 (4%) in the sedation group, respectively (P=0.928). CONCLUSION Our post COVID-19 study showed no difference in efficacy and safety between ureterorenoscopy under sedation and GA for patients with renal stones. Our results confirm the interest of the sedation procedure, particularly in the context of outpatient surgery. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Antoine Daquin
- Urology Department, Claude-Huriez Hospital, CHU de Lille, 59000 Lille, France; Urology Department, Seclin-Carvin Hospital, 59113 Seclin, France.
| | - François Marliere
- Urology Department, Claude-Huriez Hospital, CHU de Lille, 59000 Lille, France; Urology Department, Seclin-Carvin Hospital, 59113 Seclin, France
| | - Aurélien Raichi
- Urology Department, Claude-Huriez Hospital, CHU de Lille, 59000 Lille, France; Urology Department, Seclin-Carvin Hospital, 59113 Seclin, France
| | - Arthur Annoot
- Urology Department, Claude-Huriez Hospital, CHU de Lille, 59000 Lille, France; Urology Department, Seclin-Carvin Hospital, 59113 Seclin, France
| | - Cécile Journaux
- Anesthesia Department, Seclin-Carvin Hospital, 59113 Seclin, France
| | - Gilles Lebuffe
- Anesthesia Department, Claude-Huriez Hospital, CHU de Lille, 59000 Lille, France
| | - Arnauld Villers
- Urology Department, Claude-Huriez Hospital, CHU de Lille, 59000 Lille, France
| | - Gautier Marcq
- Urology Department, Claude-Huriez Hospital, CHU de Lille, 59000 Lille, France; Inserm, CNRS, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, Institut Pasteur de Lille, Université de Lille, CHU de Lille, 59000 Lille, France
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Coetzee E, Absalom AR. Pharmacokinetic and Pharmacodynamic Changes in the Elderly: Impact on Anesthetics. Anesthesiol Clin 2023; 41:549-565. [PMID: 37516494 DOI: 10.1016/j.anclin.2023.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
Anesthesiologists are increasingly required to care for frail elderly patients. A detailed knowledge of the influence of age on the pharmacokinetics and dynamics of the anesthetic drugs is essential for optimal safety and care. For most of the anesthetic drugs, the elderly need lower doses to achieve the same plasma concentrations, and at any given plasma and effect-site concentration, they will have more profound clinical effects than younger patients. Caution is required, with close monitoring of clinical effects and active titration of dose administration to achieve the desired level of effect, ideally following the "start low, go slow" principle.
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Affiliation(s)
- Ettienne Coetzee
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, D23, Observatory, Cape Town 7925, Republic of South Africa
| | - Anthony Ray Absalom
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Post Box 30.001, Groningen 9700 RB, the Netherlands.
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Simonin M, Delsuc C, Meuret P, Caruso L, Deleat-Besson R, Lamblin A, Huriaux L, Abraham P, Bidon C, Giai J, Riche B, Rimmelé T. Hypobaric Unilateral Spinal Anesthesia Versus General Anesthesia for Hip Fracture Surgery in the Elderly: A Randomized Controlled Trial. Anesth Analg 2022; 135:1262-1270. [PMID: 36135347 DOI: 10.1213/ane.0000000000006208] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Hypotension during surgery is frequent in the elderly population and is associated with acute kidney and myocardial injury, which are, themselves, associated with increased 30-day mortality. The present study compared the hemodynamic effects of hypobaric unilateral spinal anesthesia (HUSA) to general anesthesia (GA) in patients ≥70 years of age undergoing hip fracture surgery. METHODS We conducted a single-center, prospective, randomized study. In the HUSA group, patients were positioned with the operated hip above, and the hypobaric anesthetic solution was composed of 9 mg ropivacaine, 5 µg sufentanil, and 1 mL of sterile water. Anesthesia was adjusted for the GA group. Mean arterial pressure (MAP) was measured with a noninvasive blood pressure upper arm cuff every 3 minutes. Hypotension was treated with a bolus of ephedrine and then a continuous intravenous of norepinephrine to obtain a MAP ≥65 mm Hg. Primary outcome was the occurrence of severe hypotension, defined as a MAP <65 mm Hg for >12 consecutive minutes. RESULTS A total of 154 patients were included. Severe hypotension was more frequent in the GA group compared to the HUSA group (odds ratio, 5.6; 95% confidence interval, 2.7-11.7; P < .001). There was no significant difference regarding the short-term outcomes between the HUSA and GA groups: acute kidney injury (respectively, 5.1% vs 11.3%; P = .22), myocardial injury (18.0% vs 14.0%; P = .63), and 30-day mortality (2.4% vs 4.7%; P = .65). CONCLUSIONS HUSA leads to fewer episodes of severe intraoperative hypotension compared to GA in an elderly population undergoing hip fracture surgery.
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Affiliation(s)
- Marine Simonin
- From the Département d'Anesthésie-Réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Claire Delsuc
- From the Département d'Anesthésie-Réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Pascal Meuret
- From the Département d'Anesthésie-Réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Liana Caruso
- From the Département d'Anesthésie-Réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Robert Deleat-Besson
- From the Département d'Anesthésie-Réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Antoine Lamblin
- From the Département d'Anesthésie-Réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Laetitia Huriaux
- From the Département d'Anesthésie-Réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Paul Abraham
- From the Département d'Anesthésie-Réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Cyril Bidon
- From the Département d'Anesthésie-Réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Joris Giai
- Université de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France
- Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Benjamin Riche
- Université de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France
- Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Thomas Rimmelé
- From the Département d'Anesthésie-Réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
- Hospices Civils de Lyon-Biomérieux-Université Claude Bernard Lyon 1, Hôpital Édouard Herriot, Lyon, France
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Aubrun F, Baillard C, Beuscart JB, Billard V, Boddaert J, Boulanger É, Dufeu N, Friggeri A, Khiami F, Salmon PK, Merloz P, Minville V, Molliex S, Mouchoux C, Pain L, Piriou V, Raux M, Servin F. Recommandation sur l’anesthésie du sujet âgé : l’exemple de fracture de l’extrémité supérieure du fémur. ANESTHÉSIE & RÉANIMATION 2019. [DOI: 10.1016/j.anrea.2018.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Affiliation(s)
- F A Lobo
- Department of Anaesthesiology, Hospital Geral de Santo António - Centro Hospitalar do Porto, Porto, Portugal
| | - M Wagemakers
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A R Absalom
- Department of Anaesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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The Effects of Remifentanil on Hemodynamic Response Attenuation After Electroconvulsive Therapy Under Sevoflurane Anesthesia. J ECT 2017; 33:264-267. [PMID: 28520577 DOI: 10.1097/yct.0000000000000411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We evaluated the effects of a single loading dose of remifentanil (1 μg/kg) administered as an adjunct to sevoflurane, on the duration of seizure activity, recovery times, and hemodynamic profiles, during electroconvulsive therapy. METHODS The patients were randomly allocated to receive sevoflurane-saline (Group SS) or sevoflurane-remifentanil (Group SR). Sevoflurane (8%) was initiated for anesthesia induction in both groups until loss of consciousness was achieved. Remifentanil was then administered to Group SR via a 1-μg/kg intravenous bolus. Patients in Group SS received saline in the same manner. Mean arterial pressure (MAP) and heart rate (HR) were recorded before anesthetic induction (T1), at the loss of consciousness (T2), and at 0, 1, 3, and 10 minutes after the electrical stimuli were completed (T3, T4, T5, and T6, respectively). RESULTS Compared with the baseline values, HR increased significantly in Group SS at times T2 and T4 to T6 and decreased significantly in Group SR at time T2. When the groups were compared, we found that HR decreased significantly in Group SR at T2 and T4 to T6. Compared with baseline, MAP increased in Group SS between T3 and T6, and MAP decreased in Group SR at T2 and increased at T3 to T4. Mean arterial pressure decreased to a greater extent in Group SR than in Group SS during the T2 to T6 period. There were no group differences in seizure duration or recovery time. CONCLUSIONS The addition of 1-μg/kg remifentanil to anesthetic induction with sevoflurane attenuated the acute hemodynamic response to electroconvulsive therapy under sevoflurane anesthesia without adversely affecting the duration of seizure activity or the recovery profile.
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Kim TK, Hong DM, Lee SH, Paik H, Min SH, Seo JH, Jung CW, Bahk JH. Effect-site concentration of remifentanil required to blunt haemodynamic responses during tracheal intubation: A randomized comparison between single- and double-lumen tubes. J Int Med Res 2017; 46:430-439. [PMID: 28730932 PMCID: PMC6011323 DOI: 10.1177/0300060517721072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the effect-site concentration of remifentanil required to blunt haemodynamic responses during tracheal intubation with a single-lumen tube (SLT) or a double-lumen tube (DLT). Methods Patients scheduled for thoracic surgery requiring one-lung ventilation were randomly allocated to either the SLT or DLT group. All patients received a target-controlled infusion of propofol and a predetermined concentration of remifentanil. Haemodynamic parameters during intubation were recorded. The effect-site concentration of remifentanil was determined using a delayed up-and-down sequential allocation method. Results A total of 92 patients were enrolled in the study. The effective effect-site concentrations of remifentanil required to blunt haemodynamic responses in 50% of patients (EC50) estimated by isotonic regression with bootstrapping was higher in the DLT than the SLT group (8.5 ng/ml [95% confidence interval (CI) 8.0–9.5 ng/ml] versus 6.5 ng/ml [95% CI 5.6–6.7 ng/ml], respectively). Similarly, the effective effect-site concentrations of remifentanil in 95% of patients in the DLT group was higher than the SLT group (9.9 ng/ml [95% CI 9.8–10.0 ng/ml] versus 7.0 ng/ml [95% CI 6.9–7.0 ng/ml], respectively). Conclusions This study demonstrated that a DLT requires a 30% higher EC50 of remifentanil than does an SLT to blunt haemodynamic responses during tracheal intubation when combined with a target-controlled infusion of propofol. Trial registration Clinicaltrials.gov identifier: NCT01542099.
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Affiliation(s)
- Tae Kyong Kim
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Deok Man Hong
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seo Hee Lee
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyesun Paik
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Se Hee Min
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong-Hwa Seo
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chul-Woo Jung
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Hyon Bahk
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Kim JD, Kim JW, Kung HC, Kang JH, Shin HY, Kim DS, Ryu SJ, Kim KH. Hemodynamic Effects of Co-administration of Midazolam during Anesthesia Induction with Propofol and Remifentanil in Hypertensive Patients. KOSIN MEDICAL JOURNAL 2017. [DOI: 10.7180/kmj.2017.32.1.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives Propofol, midazolam and remifentanil are commonly used for clinical anesthesia. We compared the effects of midazolam-propofol-remifentanil and propofol-remifentanil on hemodynamic responses during anesthesia induction in hypertensive patients. Methods Seventy-six hypertensive patients with ASA II-III were assigned to receive midazolam-propofol (group MP; n = 38) or propofol (group P; n = 38). Anesthesia was induced with midazolam 0.03 mg/kg (group MP) or saline 0.03 ml/kg (group P). After two minutes, propofol 1.0 mg/kg (group MP) or 1.5 mg/kg (group P) i.v. bolus was administered. Simultaneously, 4 ng/ml of remifentanil target controlled infusion (TCI) was administered in both groups. Anesthesia was maintained using sevoflurane and 2 ng/ml of remifentanil TCI. Systolic, diastolic, and mean blood pressure (SBP, DBP, and MBP) and heart rate (HR) were measured before induction, 2 min after midazolam or normal saline, 2 min after propofol, 1 min after rocuronium, and immediately, 1 min, 2 min, and 3 min after intubation. Results SBP, DBP, and MBP decreased after propofol administration and increased immediately after intubation in both groups ( P < 0.05). After intubation, SBP, DBP, and MBP decreased more than baseline values in either group. Although the overall BP of Group P was lower than that of Group MP, there were no significant differences except for SBP at 2min after intubation ( P < 0.05). HR was no significant difference in either group. Conclusion Our results suggest that midazolam-propofol-remifentanil has similar hemodynamic effect with propofol-remifentanil during anesthesia induction in hypertensive patients.
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Rezaiguia-Delclaux S, Laverdure F, Kortchinsky T, Lemasle L, Imbert A, Stéphan F. Fiber optic bronchoscopy and remifentanil target-controlled infusion in critically ill patients with acute hypoxaemic respiratory failure: A descriptive study. Anaesth Crit Care Pain Med 2016; 36:273-277. [PMID: 27867133 DOI: 10.1016/j.accpm.2016.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 06/07/2016] [Accepted: 07/11/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Sedation optimizes patient comfort and ease of execution during fiber optic bronchoscopy (FOB). Our objective was to describe the safety and efficacy of remifentanil-TCI during FOB in non-intubated, hypoxaemic, thoracic surgery ICU patients. METHODS Consecutive spontaneously breathing adults requiring FOB after thoracic surgery were included if they had hypoxaemia (PaO2/FiO2<300mmHg or need for non-invasive ventilation [NIV]) and prior FOB failure under topical anaesthesia. The remifentanil initial target was chosen at 1ng/mL brain effect-site concentration (Cet), then titrated to 0.5ng/mL Cet increments according to patient comfort and coughing. Outcomes were patient-reported pain and discomfort (Visual Analogue Scale scores), ventilatory support intensification within 24hours after bronchoscopy, and ease of FOB execution. RESULTS Thirty-nine patients were included; all had a successful FOB. Their median PO2/FiO2 before starting FOB was 187±84mmHg and 24 patients received NIV. Median [interquartile range] pain scores were not different before and after FOB (1.0 [0.0-3.0] and 0.0 [0.0-2.0], respectively). Discomfort was reported as absent or minimal by 27 patients (69%; 95% confidence interval [95% CI], 54-81%) and as bothersome but tolerable by 12 patients (31%; 95% CI, 19-46%). Mean FiO2 returned to baseline within 2hours after FOB in 30 patients; the remaining 9 patients (23%; 95% CI, 13-38%) received ventilatory support intensification. Ease of execution was good or very good in 34 patients (87%; 95% CI, 73-94%), acceptable in 4 patients, and poor in 1 patient (persistent cough). CONCLUSION Sedation with remifentanil-TCI during FOB with prior failure under topical anaesthesia alone was effective and acceptably safe in non-intubated hypoxaemic thoracic surgery patients.
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Affiliation(s)
- Saïda Rezaiguia-Delclaux
- Cardiothoracic Intensive Care Unit, hôpital Marie-Lannelongue, 133, avenue de la Résistance, 92350 Le Plessis-Robinson, France; Université Paris Sud, Paris, France.
| | - Florent Laverdure
- Cardiothoracic Intensive Care Unit, hôpital Marie-Lannelongue, 133, avenue de la Résistance, 92350 Le Plessis-Robinson, France; Université Paris Sud, Paris, France
| | - Talna Kortchinsky
- Cardiothoracic Intensive Care Unit, hôpital Marie-Lannelongue, 133, avenue de la Résistance, 92350 Le Plessis-Robinson, France; Université Paris Sud, Paris, France
| | - Léa Lemasle
- Cardiothoracic Intensive Care Unit, hôpital Marie-Lannelongue, 133, avenue de la Résistance, 92350 Le Plessis-Robinson, France; Université Paris Sud, Paris, France
| | - Audrey Imbert
- Cardiothoracic Intensive Care Unit, hôpital Marie-Lannelongue, 133, avenue de la Résistance, 92350 Le Plessis-Robinson, France; Université Paris Sud, Paris, France
| | - François Stéphan
- Cardiothoracic Intensive Care Unit, hôpital Marie-Lannelongue, 133, avenue de la Résistance, 92350 Le Plessis-Robinson, France; Université Paris Sud, Paris, France
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Inducción con propofol: infusión controlada por objetivo o manual. Un estudio observacional. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1016/j.rca.2016.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Manual vs. target-controlled infusion induction with propofol: An observational study. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1016/j.rcae.2016.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Rosero EB. Characterizing depth of anesthesia during target-controlled infusions: Not an easy job. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1016/j.rcae.2016.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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La caracterización de la profundidad de la anestesia durante las infusiones controladas a objetivo: no es un trabajo fácil. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1016/j.rca.2016.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Seok U, Ji S, Yoo S, Kim J, Kim S, Kim J. A survey of the intravenous sedation status in one provincial dental clinic center for the disabled in Korea. J Dent Anesth Pain Med 2016; 16:123-129. [PMID: 28879305 PMCID: PMC5564081 DOI: 10.17245/jdapm.2016.16.2.123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 01/02/2023] Open
Abstract
Background The objective of the present study was to examine the status of patients who had received dental treatment under intravenous (IV) sedation at Chungnam Dental Clinic for the Disabled in Korea from its inception to the present time, and to review the analysis results. Methods Retrospective analysis was performed on 305 cases of patients who had received dental treatments under IV sedation between January 2011 and May 2016. The analysis examined the patient's sex, age, primary reason for IV sedation, duration of anesthesia and dental treatment, type of dental treatment performed, number of clinical departments involved in the dental treatment and level of multidisciplinary cooperation, and annual trends. Results Most dental treatments using intravenous sedation were performed on medically disabled patients or dentally disabled patients with an extreme gag reflex or dental phobia. The mean duration of IV sedation was 72.5 min, while the mean duration of treatment was 58.0 min. The types of dental treatments included surgical treatment (n = 209), periodontal treatment (n = 28), prosthodontic treatment (n = 28), restorative treatment (n = 23), implant surgery (n = 22), endodontic treatment (n = 9), reduction of temporomandibular joint dislocation (n = 1), and treatment of traumatic injuries (n = 1), with treatments mostly performed on adult patients. Conclusions With increasing demand for minimally painful treatment, cases using IV sedation are on an upward trend and are expected to continue to increase.
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Affiliation(s)
- Ujeong Seok
- Department of Pediatric Department, School of Dentistry, Dankook University, Cheonan, Korea
| | - Sangeun Ji
- Department of Pediatric Department, School of Dentistry, Dankook University, Cheonan, Korea
| | - Seunghoon Yoo
- Department of Pediatric Department, School of Dentistry, Dankook University, Cheonan, Korea
| | - Jongsoo Kim
- Department of Pediatric Department, School of Dentistry, Dankook University, Cheonan, Korea
| | - Seungoh Kim
- Department of Anesthesiology, School of Dentistry, Dankook University, Cheonan, Korea
| | - Jongbin Kim
- Department of Pediatric Department, School of Dentistry, Dankook University, Cheonan, Korea
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Yao Y, Yu C, Yuan Y, Huang G, Li S. Median effective concentration of remifentanil in target controlled infusion for smooth tracheal extubation during emergence from general anesthesia in elderly patients. J Clin Anesth 2016; 31:13-8. [DOI: 10.1016/j.jclinane.2015.12.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 12/08/2015] [Accepted: 12/28/2015] [Indexed: 12/17/2022]
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Ramírez DE, Calvache JA. Design and performance evaluation of the “iTIVA” algorithm for manual infusion of intravenous anesthetics based on effect-site target. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1016/j.rcae.2016.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Ramírez DE, Calvache JA. Diseño y evaluación del desempeño del algoritmo «iTIVA» para la administración manual de anestésicos intravenosos según objetivo en sitio efecto. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1016/j.rca.2016.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
The use of opioids may seem to be a double-edged sword; they provide straight analgesic and antihyperalgesic effects initially, but subsequently are associated with the expression of acute opioid tolerance (AOT) and opioid-induced hyperalgesia (OIH) that have been reported in experimental studies and clinical observations. It has been suggested that opioids can induce an acute tolerance and hyperalgesia in dose- and/or time-dependent manners even when used within the clinically accepted doses. Recently, remifentanil has been used for pain management in clinical anesthesia and in the intensive care units because of its rapid onset and offset. We reviewed articles analyzing AOT and/or OIH by remifentanil and focused on the following issues: (1) evidence of remifentanil inducing AOT and/or OIH and (2) importance of AOT and/or OIH in considering the reduction of remifentanil dosage or adopting preventive modulations. Twenty-four experimental and clinical studies were identified using electronic searches of MEDLINE (PubMed, Ovid, Springer, and Elsevier). However, the development of AOT and OIH by remifentanil administration remains controversial. There is no sufficient evidence to support or refute the existence of OIH in humans.
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Manual vs. target-controlled infusion induction with propofol: An observational study☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1097/01819236-201644040-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Design and performance evaluation of the “iTIVA” algorithm for manual infusion of intravenous anesthetics based on effect-site target☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1097/01819236-201644020-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Characterizing depth of anesthesia during target-controlled infusions: Not an easy job☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1097/01819236-201644030-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
Anesthesia is a combination of unconsciousness, amnesia, and analgesia, expressed in sleeping patients by limited reaction to noxious stimulations. It is achieved by several classes of drugs, acting mainly on central nervous system. Compared to other therapeutic families, the anesthetic drugs, administered by intravenous or pulmonary route, are quickly distributed in the blood and induce in a few minutes effects that are fully reversible within minutes or hours. These effects change in parallel with the concentration of the drug, and the concentration time course of the drug follows with a reasonable precision mathematical models based on the Fick principle. Therefore, understanding concentration time course allows adjusting the dosing delivery scheme in order to control the effects. The purpose of this short review is to describe the basis of pharmacokinetics and modeling, the concentration-effects relationship, and drug interactions modeling to offer to anesthesiologists and non-anesthesiologists an overview of the rules to follow to optimize anesthetic drug delivery.
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Affiliation(s)
- Valerie Billard
- Department of Anesthesia and surgical intensive care, Gustave Roussy Cancer Center, 114, rue Édouard-Vaillant, VILLEJUIF, 94805, France
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Schraag S. The Current Role of Total Intravenous Anesthesia in Cardiac Surgery: Total Intravenous Anesthesia and Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2015; 29 Suppl 1:S27-30. [DOI: 10.1053/j.jvca.2015.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Indexed: 11/11/2022]
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Zou ZY, Zhao YL, Yang XL, Zhang GY, Zhou HG. Effects of different remifentanil target concentrations on MAC BAR of sevoflurane in gynaecological patients with CO 2 pneumoperitoneum stimulus. Br J Anaesth 2015; 114:634-9. [DOI: 10.1093/bja/aeu400] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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El-Tahan MR, Regal M. Target-Controlled Infusion of Remifentanil Without Muscle Relaxants Allows Acceptable Surgical Conditions During Thoracotomy Performed Under Sevoflurane Anesthesia. J Cardiothorac Vasc Anesth 2015; 29:1557-66. [PMID: 26022912 DOI: 10.1053/j.jvca.2015.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To test the hypothesis that the use of a nonmuscle relaxant anesthetic technique (NMRT) during thoracotomy would be associated with comparable surgical conditions with the standard use of neuromuscular blocking drugs. DESIGN A prospective, randomized, single-blind, controlled study. SETTING A single university hospital. PARTICIPANTS Sixty-six patients scheduled for open thoracotomy under sevoflurane anesthesia with a target-controlled infusion (TCI) of remifentanil. INTERVENTIONS After ethical approval, patients were randomly assigned to receive cisatracurium or saline (n = 33 for each group) during the entire study period. MEASUREMENTS AND MAIN RESULTS The four-point ordinal surgical rating scale, the intubating conditions, the use of anesthetics and vasopressors, the incidence of light anesthesia (defined as an episode with state entropy values that exceeded 50 and/or mean arterial blood pressure and heart rate values that exceeded the baseline by 20% and lasted for more than 3 consecutive minutes), and the times to clinical recovery and postanesthesia care unit (PACU) discharge, hospital stays, and postoperative residual curarization (PORC) were recorded. Compared with the use of cisatracurium, the use of NMRT resulted in comparable good-to-excellent surgical rating scales (90.9% v 94.0%, respectively; p = 0.642), good-to-excellent laryngoscopy and endobronchial intubating conditions (93.9% v 100%, respectively; p>0.09), use of anesthetic and vasopressor medications, and hospital stays, together with shorter clinical recovery, extubation times (7.6 [95% CI 6.82 to 8.39] v 19.0 [95% CI 15.76 to 22.23] minutes, respectively; p<0.001), and PACU stays (37.4 [95% CI 35.09 to 39.79] v 70.9 [95% CI 56.90 to 84.91] minutes, respectively; p<0.001). The use of cisatracurium resulted in a nonstatistical number of light anesthesia episodes upon positioning, skin incision, and rib separation (p>0.624, with Fisher's exact test). There were no failed intubations in the 2 groups. No patient received cisatracurium in the NMRT group. Two patients (6.1%) in the cisatracurium group experienced PORC that required tracheal intubation in the PACU. CONCLUSION The use of TCI of remifentanil with NMRT offers acceptable laryngoscopy, intubating, and surgical conditions during sevoflurane anesthesia for open thoracotomy, especially when. the anesthesiologists have more than 10 years' experience.
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Affiliation(s)
- Mohamed R El-Tahan
- Departments of Anesthesiology; Department of Anesthesiology, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt.
| | - Mohamed Regal
- Surgery, King Fahd Hospital of the University of Dammam, Dammam, Saudi Arabia
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Carter R, Richardson A, Santoro J, Beddows S, McCarthy EJ. Is Dexmedetomidine More Effective Than Remifentanil for Neurologic Outcomes in Patients Undergoing CEA Surgery Using Regional Anesthesia? J Perianesth Nurs 2014; 29:466-74. [DOI: 10.1016/j.jopan.2014.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 07/09/2014] [Accepted: 07/09/2014] [Indexed: 10/24/2022]
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Target-controlled infusion and population pharmacokinetics of landiolol hydrochloride in gynecologic patients. J Anesth 2014; 29:198-205. [DOI: 10.1007/s00540-014-1908-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 08/14/2014] [Indexed: 12/19/2022]
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Muñoz L, Arévalo JJ, Reyes LE, Balaguera CE. Remifentanilo versus propofol con infusión controlada a objetivo en sitio efecto para la sedación de pacientes durante procedimientos endoscópicos gastrointestinales: ensayo clínico controlado aleatorizado. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1016/j.rca.2012.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Muñoz L, Arévalo JJ, Reyes LE, Balaguera CE. Remifentanil vs. propofol controlled infusion for sedation of patients undergoing gastrointestinal endoscopic procedures: A clinical randomized controlled clinical trial. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1016/j.rcae.2012.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Johnston KD, Rai MR. Conscious sedation for awake fibreoptic intubation: a review of the literature. Can J Anaesth 2013; 60:584-99. [PMID: 23512191 DOI: 10.1007/s12630-013-9915-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 03/05/2013] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Awake fibreoptic intubation (AFOI) is the gold standard of management of the predicted difficult airway. Sedation is frequently used to make the process more tolerable to patients. It is not always easy to strike a balance between patient comfort and good intubating conditions on the one hand and maintaining ventilation and a patent airway on the other. In the last 30 years, many drugs and drug combinations have been described, but there is very little in the literature to help guide the practitioner to choose between them. The objective of this article is to discuss the evidence supporting the use of the agents described with regard to their efficacy, recommended doses and techniques, and limitations to their use for AFOI. SOURCE Publication databases were searched for articles published from 1996 to 2012 relating to sedation for AFOI. PRINCIPLE FINDINGS Benzodiazepines, propofol, opioids, alpha2-adrenoceptor agonists, and ketamine are the main classes of drugs that have been described to facilitate AFOI. Drugs that are most suitable have a combination of both anxiolytic and analgesic properties. The ideal choice of drug may vary depending on the patient and the indication for AFOI. CONCLUSION There is good evidence to support the use of two drugs in particular, remifentanil and dexmedetomidine. Each has certain unique characteristics that make them an attractive choice for an AFOI.
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Affiliation(s)
- Kevin D Johnston
- Department of Anesthesia, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK.
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Remifentanil vs. propofol controlled infusion for sedation of patients undergoing gastrointestinal endoscopic procedures: A clinical randomized controlled clinical trial☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1097/01819236-201341020-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Usefulness of Intravenous Anesthesia Using a Target-controlled Infusion System with Local Anesthesia in Submuscular Breast Augmentation Surgery. Arch Plast Surg 2012; 39:540-5. [PMID: 23094252 PMCID: PMC3474413 DOI: 10.5999/aps.2012.39.5.540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 08/14/2012] [Accepted: 08/14/2012] [Indexed: 11/12/2022] Open
Abstract
Background Patients have anxiety and fear of complications due to general anesthesia. Through new instruments and local anesthetic drugs, a variety of anesthetic methods have been introduced. These methods keep hospital costs down and save time for patients. In particular, the target-controlled infusion (TCI) system maintains a relatively accurate level of plasma concentration, so the depth of anesthesia can be adjusted more easily. We conducted this study to examine whether intravenous anesthesia using the TCI system with propofol and remifentanil would be an effective method of anesthesia in breast augmentation. Methods This study recruited 100 patients who underwent breast augmentation surgery from February to August 2011. Intravenous anesthesia was performed with 10 mg/mL propofol and 50 µg/mL remifentanil simultaneously administered using two separate modules of a continuous computer-assisted TCI system. The average target concentration was set at 2 µg/mL and 2 ng/mL for propofol and remifentanil, respectively, and titrated against clinical effect and vital signs. Oxygen saturation, electrocardiography, and respiratory status were continuously measured during surgery. Blood pressure was measured at 5-minute intervals. Information collected includes total duration of surgery, dose of drugs administered during surgery, memory about surgery, and side effects. Results Intraoperatively, there was transient hypotension in two cases and hypoxia in three cases. However, there were no serious complications due to anesthesia such as respiratory difficulty, deep vein thrombosis, or malignant hypertension, for which an endotracheal intubation or reversal agent would have been needed. All the patients were discharged on the day of surgery and able to ambulate normally. Conclusions Our results indicate that anesthetic methods, where the TCI of propofol and remifentanil is used, might replace general anesthesia with endotracheal intubation in breast augmentation surgery.
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Flexible fiberoptic bronchoscopy and remifentanil target-controlled infusion in ICU: a preliminary study. Intensive Care Med 2012; 39:53-8. [PMID: 23052952 DOI: 10.1007/s00134-012-2697-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 08/15/2012] [Indexed: 12/17/2022]
Abstract
PURPOSE Flexible fiberoptic bronchoscopy (FFB) is a major diagnostic tool commonly used in intensive care unit (ICU). However, it generates discomfort and pain and can worsen respiratory and/or hemodynamic condition of critically ill patients. Remifentanil is an ultrashort-acting opioid drug that has been shown to provide effective sedation for painful procedures in spontaneous breathing patients. The aim of this study is to evaluate the safety and efficacy of sedation with remifentanil target-controlled infusion (Remi-TCI) in patients with spontaneous ventilation undergoing FFB in ICU. METHODS Monocentric prospective study. All patients received Remi-TCI with initial effect-site target concentration of 2 ng/mL, progressively titrated according to their comfort and sedation. Respiratory and hemodynamic parameters were assessed before, during, and after the procedure, as well as comfort, level of sedation, FFB conditions, and recovery patterns. Global Remi-TCI data and potential complications of the procedure were also recorded. RESULTS Fourteen patients were included. FFB was successful in all patients with good conditions (sedation, global comfort, and cough). No severe hemodynamic or respiratory complications occurred during procedure. Maximum target concentration and total dose of remifentanil were 2.5 ng/mL (2-4 ng/mL) and 1.4 μg/kg (0.7-2.4 μg/kg), respectively, over 10 min. Patients reported low level of pain and good satisfaction with the procedure. CONCLUSIONS FFB under sedation with Remi-TCI seems to be safe and effective in critically ill patients with spontaneous ventilation. Such results could be the first step towards wider use of Remi-TCI in patients experiencing awkward and/or painful procedures in this setting.
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Lim YS, Kang DH, Kim SH, Jang TH, Kim KH, Ryu SJ, Yu SB, Kim DS. The cardiovascular effects of midazolam co-induction to propofol for induction in aged patients. Korean J Anesthesiol 2012; 62:536-42. [PMID: 22778889 PMCID: PMC3384791 DOI: 10.4097/kjae.2012.62.6.536] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 11/02/2011] [Accepted: 11/02/2011] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate whether a small dose of midazolam and lessening the propofol dosage could prevent cardiovascular change at tracheal intubation for induction in aged patients. METHODS Eighty patients over 65 years (ASA physical status 1, 2) scheduled for elective surgery received general anesthesia with remifentanil and propofol or midazolam. Patients in group P (n = 40) were induced with 0.9% NaCl 0.03 ml/kg, propofol 1. 2 mg/kg and remifentanil. Patients in group MP (n = 40) were induced with midazolam 0.03 mg/kg, propofol 0.8 mg/kg and remifentanil. The time taken to reach loss of consciousness (LOC) and the value of bispectral index score (BIS) at LOC were recorded. After LOC, 0.8 mg/kg of rocuronium was given and tracheal intubation was performed. The mean blood pressure (MBP) and heart rate (HR) were recorded before induction as the base value, before intubation, immediately post-intubation and 3 minutes after intubation. RESULTS Compared with the base values, MBP at before intubation and 3 minutes after intubation was significantly decreased in group P and group MP (P < 0.05). Compared with group P, the decrease of MBP was significantly less at before intubation, immediately after intubation and 3 minutes after intubation in group MP (P < 0.05). The time taken to reach LOC was significantly decreased in group MP compared with that in group P (P < 0.05). There were no significant differences of HR at any time between the two groups. CONCLUSIONS Co-induction with midazolam and propofol could prevent a marked BP decrease at tracheal intubation for induction in aged patients.
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Affiliation(s)
- Young Soo Lim
- Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea
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Park SJ, Shim YH, Yoo JH, Nam SH, Lee JW. Low-dose remifentanil to modify hemodynamic responses to tracheal intubation: comparison in normotensive and untreated/treated hypertensive Korean patients. Korean J Anesthesiol 2012; 62:135-41. [PMID: 22379568 PMCID: PMC3284735 DOI: 10.4097/kjae.2012.62.2.135] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 06/30/2011] [Accepted: 07/07/2011] [Indexed: 11/24/2022] Open
Abstract
Background Remifentanil has been shown to be effective at treating potentially adverse hemodynamic responses to tracheal intubation even at low doses (< 1 µg/kg/min), which needs to be evaluated in patients with diverse cardiovascular conditions. Methods A low-dose regimen of remifentanil (continuous infusion of 0.1 µg/kg/min, preceded by 0.5 µg/kg bolus) was given before induction with bolus propofol and rocuronium, and heart rate as well as systolic, diastolic, and mean arterial pressures were measured at 1 min intervals from before induction to 5 min after tracheal intubation in normotensive patients, untreated hypertensive patients, and patients with known hypertension. Results The low-dose regimen of remifentanil resulted in parallel hemodynamic responses in all three groups, and was effective at limiting hemodynamic responses to tracheal intubation without excessive cardiovascular depression. Hemodynamic responses in our study showed a similar pattern to that reported in previous investigations, except for elevations in heart rate and arterial pressures over the baseline values immediately after intubation. Conclusions We suggest that the low-dose regimen of remifentanil in our study could be routinely used to modify hemodynamic responses to tracheal intubation in patients with diverse hemodynamic characteristics. However, the development of supplementary regimens is still needed to control the brief, but exaggerated responses to tracheal intubation, especially in untreated hypertensive patients.
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Affiliation(s)
- Soo Jung Park
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
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Richebé P, Pouquet O, Jelacic S, Mehta S, Calderon J, Picard W, Rivat C, Cahana A, Janvier G. Target-Controlled Dosing of Remifentanil During Cardiac Surgery Reduces Postoperative Hyperalgesia. J Cardiothorac Vasc Anesth 2011; 25:917-25. [DOI: 10.1053/j.jvca.2011.03.185] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Indexed: 11/11/2022]
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Yepes Temiño MJ, Panadero Sánchez A, Callejas González R, Carrascosa Moreno F, Pérez Valdivieso JR. [An awake fiberoptic intubation protocol: descriptive retrospective assessment of safety and efficacy]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2011; 58:80-84. [PMID: 21427823 DOI: 10.1016/s0034-9356(11)70005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND OBJECTIVE Flexible fiberoptic intubation of the trachea is emphasized in guidelines on the management of difficult airway. The aim of this study was to analyze the efficacy and safety of our tertiary hospital's awake fiberoptic intubation protocol. MATERIAL AND METHODS For retrospective descriptive study we collected information on all fiberoptic intubations performed on awake patients in the 3 years after a specific protocol was implemented. The protocol's key points focus on operating room arrangement, required staff, and sedation before the procedure. Data gathered included demographic variables, patients' diseases, preanesthetic assessment of potential difficult airway, adherence to the protocol, medication administered, and complications recorded. RESULTS In the course of the study, 634 fiberoptic intubations were performed; 473 patients (74.6%) had at least 1 risk factor for aspiration and 232 patients (36.5%) had at least 1 type of cardiovascular comorbidity. Difficult intubation was expected in 67%. In 99%, remifentanil was administered via target controlled infusion with a mean effect concentration of 2.9 ng/mL. The operating room arrangement and staffing protocol was followed in all cases. No pulmonary or hemodynamic complications occurred during fiberoptic intubation or immediately after surgery. CONCLUSION Our hospital's protocol was followed in all cases and no post-implementation complications were detected.
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Affiliation(s)
- M J Yepes Temiño
- Servicio de Anestesiología y Reanimación, Clínica Universidad de Navarra, Pamplona.
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Yoo KY, Jeong CW, Kim SJ, Jeong ST, Kim WM, Lee HK, Oh KJ, Lee JU, Shin MH, Chung SS. Remifentanil Decreases Sevoflurane Requirements to Block Autonomic Hyperreflexia During Transurethral Litholapaxy in Patients with High Complete Spinal Cord Injury. Anesth Analg 2011; 112:191-7. [DOI: 10.1213/ane.0b013e3181fc7139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
PURPOSE OF REVIEW Anesthesiologists are overloaded with information and multitasking necessities in an extremely complex work environment. The purpose of this review is to present recent developments toward automated anesthesia and present future technologies for everyday clinical practice. RECENT FINDINGS Decision support systems integrate different parameters, clinical scenarios and assessments by (non)-trained personnel into algorithms, which lead to diagnostic suggestions, triage evaluations or treatment options. Target-controlled anesthesia infusion systems reduce the anesthesiologist's workload; target-controlled analgesia systems have the potential to provide more stable hemodynamic control. Closed-loop delivery of anesthesia is feasible and provides anesthetic control as good as or better than human delivery. Teleanesthesia offers the possibility of distant preoperative assessment of the patient's fitness for anesthesia, aid of trained personnel to perform anesthetic tasks and the control of anesthesia delivery in a distant location. SUMMARY Decision support systems help to make reliable and standardized decisions in complex environments. Target-controlled infusion systems reduce the anesthetic workload. Closed-loop systems will automate anesthesia care in the near future. Teleanesthesia offers the opportunity to provide safe anesthetic care whenever trained personnel are not available or need support.
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Vetrugno L, Di Luca E, Drigo D, Fregonese V, Gonano N, Giordano F. Wake-up test decrease shunts insertion during carotid endarterectomy under general anesthesia. Vasc Endovascular Surg 2010; 44:174-8. [PMID: 20150229 DOI: 10.1177/1538574409359428] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The use of locoregional anesthesia versus general anesthesia (GE) in carotid endarterectomy (CEA) has been a debatable issue in clinical studies for the past several years. In our study, GE with wake-up tests (WUTs) during carotid cross-clamping was used instead of stump pressure (SP) to directly assess the neurological status of the patient to determine whether shunting was needed. Our study assessed the percentage of patients under light sedation and mechanically ventilated needing shunting based on WUT compared to a systolic stump pressure (SPs) cutoff value of <or=40 mm Hg. DESIGN Retrospective, observational study. SETTING University hospital clinic. PARTICIPANTS Three hundred fifty-one patients (American Society of Anesthesiologists physical class II-III) with carotid artery stenosis scheduled for CEA under GE. INTERVENTIONS The WUT was used to assess the neurological status in patients undergoing CEA, which involved the gradual reduction of depth of anesthesia until the patient was capable of responding to a verbal stimulus and provide full collaboration while only receiving remifentanil. A positive WUT indicated that patient was not able to carry out the order. MEASUREMENTS AND MAIN RESULTS Of 343 patients, 20 (5.8%) were shunted due to a positive WUT after cross-clamping in comparison to 45 patients (12.8%) based on the SPs <or=40 mm Hg criteria. CONCLUSION Wake-up test can be used to directly assess the neurological status in patients undergoing CEA to determine whether shunting is required. Our results showed that less patients required shunting based on WUT compared to the SP criteria.
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Affiliation(s)
- Luigi Vetrugno
- Cardiothoracic and Vascular Anesthesia, University-Hospital of Udine, Udine, Italy.
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Honda N, Nakade S, Kasai H, Hashimoto Y, Ohno T, Kitagawa J, Yamauchi A, Hasegawa C, Kikawa S, Kunisawa T, Tanigawara Y, Miyata Y. Population pharmacokinetics of landiolol hydrochloride in healthy subjects. Drug Metab Pharmacokinet 2009; 23:447-55. [PMID: 19122339 DOI: 10.2133/dmpk.23.447] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Landiolol hydrochloride is a newly developed cardioselective, ultra short-acting beta(1)-adrenergic receptor blocking agent used for perioperative arrhythmia control. The objective of this study was to characterize the population pharmacokinetics of landiolol hydrochloride in healthy male subjects. A total of 420 blood concentration data points collected from 47 healthy male subjects were used for the population pharmacokinetic analysis. NONMEM was used for population pharmacokinetic analysis. In addition, the final pharmacokinetic model was evaluated using a bootstrap method and a leave-one-out cross validation method. The concentration time course of landiolol hydrochloride was best described by a two-compartment model with lag time. The final parameters were total body clearance (CL: 36.6 mL/min/kg), distribution volume of the central compartment (V1: 101 mL/kg), inter-compartmental clearance (16.1 mL/min/kg), distribution volume of the peripheral compartment (55.6 mL/kg), and lag time (0.82 min). The inter-individual variability in the CL and V1 were 21.8% and 46.3%, respectively. The residual variability was 22.1%. Model evaluation by the two different methods indicated that the final model was robust and parameter estimates were reasonable. The population pharmacokinetic model for landiolol hydrochloride in healthy subjects was developed and was shown to be appropriate by both bootstrap and leave-one-out cross validation methods.
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Affiliation(s)
- Naoki Honda
- Pharmacokinetic Research Laboratories, Ono Pharmaceutical Co., Ltd., Ibaraki, Japan
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Nho JS, Lee SY, Kang JM, Kim MC, Choi YK, Shin OY, Kim DS, Kwon MI. Effects of maintaining a remifentanil infusion on the recovery profiles during emergence from anaesthesia and tracheal extubation. Br J Anaesth 2009; 103:817-21. [PMID: 19864308 DOI: 10.1093/bja/aep307] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Emergence from anaesthesia and tracheal extubation can be associated with hyperdynamic circulatory responses. We examined the effects of maintaining a remifentanil infusion on recovery profiles such as coughing and cardiovascular responses after general anaesthesia. METHODS Forty patients undergoing endoscopic sinus surgery under general anaesthesia using total i.v. anaesthesia (propofol and remifentanil) were randomly allocated to a control group (n=20) or remifentanil group (n=20) during emergence from anaesthesia. At the end of surgery, propofol was ceased and the infusion of remifentanil was stopped in the control group and maintained in the remifentanil group at a target organ concentration of 1.5 ng ml(-1) until extubation. Heart rate (HR), mean arterial pressure (MAP), and recovery profiles were measured and evaluated. RESULTS There was no significant difference in sex ratio, age, weight, height, time to eye opening, time to extubation, nausea, visual analogue scale, and time to discharge. Increases in HR and MAP occurred during emergence in the control group compared with baseline values. Increases in HR were attenuated in the remifentanil group and MAP decreased during recovery compared with baseline values. HR and MAP values were significantly higher in the control group [103 (23) beats min(-1), 129 (17) mm Hg] compared with the remifentanil group [79 (17) beats min(-1), 112 (15) mm Hg] during emergence and tracheal extubation. Moderate or severe coughing was observed only in the control group (8/20 vs 0/20, P<0.001). CONCLUSIONS Maintaining a remifentanil infusion reduced haemodynamic changes and coughing associated with tracheal extubation almost without significantly delaying recovery from anaesthesia.
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Affiliation(s)
- J-S Nho
- Department of Anesthesiology, Kyung Hee University Hospital, Seoul, Republic of Korea
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Kim JH, Yoon HS, Lee SY, Shin YS, Yoon SH, Choi YH. Adequate sevoflurane concentrations in inhalation induction of sevoflurane following administration of remifentanil. Korean J Anesthesiol 2009; 57:170-175. [PMID: 30625852 DOI: 10.4097/kjae.2009.57.2.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Currently, sevoflurane and remifentanil are utilized frequently for the inhalation induction of anesthesia. However, there is currently an insufficient amount of clinical data regarding the inhalation induction of sevoflurane after the administration of remifentanil. METHODS 80 patients undergoing elective surgery were allocated randomly to four groups. Group A inhaled only sevoflurane at 8 vol%. Other groups were administered 3 ng/ml of remifentanil and inhaled sevoflurane at 8 vol% (group B) or 6 vol% (group C) or 4 vol% (group D). All groups also received 0.6 mg/kg of rocuronium. The blood pressure and heart rate were measured at pre-induction, and before and after tracheal intubation. After operation, the patients??levels of satisfaction with the inhalation induction were evaluated. RESULTS The time to loss of consciousness was substantially longer in group D than in the other groups, but no significant differences were noted among the groups in terms of satisfaction scores. The HR in groups B, C and D increased significantly after pre-intubation as compared to baseline in group A. The HR decreased significantly during induction as compared to group A. The MAP in groups B, C and D decreased significantly at 1 and 2 minutes after tracheal intubation as compared to group A. In group D only, we noted no significant differences in the MAP as compared to baseline at 1, 2 minutes after tracheal intubation. CONCLUSIONS 4 vol% sevoflurane was a more appropriate concentration for the inhalation induction of anesthesia when coupled with 3 ng/ml of remifentanil.
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Affiliation(s)
- Jeong Hyun Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea.
| | - Hee Suk Yoon
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea.
| | - Sun Yeul Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea.
| | - Yong Sup Shin
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea.
| | - Seok Hwa Yoon
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea.
| | - Youn Hee Choi
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea.
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Son MK, Lee GY, Kim CH, Chung RK. The effects of midazolam and remifentanil on induction of anesthesia and hemodynamics during tracheal intubation under target-controlled infusion of propofol. Korean J Anesthesiol 2009; 56:619-623. [PMID: 30625799 DOI: 10.4097/kjae.2009.56.6.619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The combined induction using two or more agents has a potential benefit that anesthesia could be induced with smaller anesthetic agents with fewer side effects. We studied the effects of co-administration with midazolam and remifentanil on the dose of propofol, the time to loss of consciousness (LOC) and hemodynamics during tracheal intubation. METHODS Sixty patients were randomly assigned to three groups. Group 1 was induced with target-controlled propofol alone. Group 2 received midazolam (0.05 mg/kg) and target-controlled propofol. Group 3 received midazolam (0.025 mg/kg), remifentanil (2 ng/ml) and target-controlled propofol. The time to LOC, the infused propofol dose and the effect site concentration at LOC were recorded. After LOC, rocuronium (0.6 mg/kg) was given and tracheal intubation was performed. The noninvasive blood pressure, heart rate (HR) and bispectral index were recorded. RESULTS The time and the dose of propofol to LOC were significantly reduced in group 2, 3 than in group 1 (P < 0.05). Compared with pre-induction values, mean blood pressure at immediately after intubation was increased in group 1, 2 with no change in group 3. The HR immediately after intubation was significantly increased in all groups compared to the pre-induction values, but the rate of increase of HR in group 3 were significantly lower than those group 1, 2 (P < 0.05). CONCLUSIONS The co-administration with midazolam and remifentanil reduces the time to LOC and the dose of propofol. That also attenuates hemodynamics during tracheal intubation under target-controlled infusion of propofol.
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Affiliation(s)
- Mi Kyoung Son
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
| | - Guie Yong Lee
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
| | - Chi Hyo Kim
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
| | - Rack Kyung Chung
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
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Oh HJ, Kim YH, Lee JU. The optimal effect site concentration of remifentanil for tracheal intubation without muscle relaxant during inhalation anesthetic induction using sevoflurane in adult. Korean J Anesthesiol 2009; 56:639-645. [PMID: 30625803 DOI: 10.4097/kjae.2009.56.6.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sevoflurane has been shown to be suitable for inhalation induction of anesthesia in adults. The addition of remifentanil during sevoflurane induction allows for rapid and smooth tracheal intubation without muscle relaxant. The high concentration of remifentanil can result in improved conditions for tracheal intubation but also caused a cardiovascular instability. We tried to estimate optimal effect site concentration of remifentanil for tracheal intubation without muscle relaxants during inhalation anesthetic induction with 8 vol% sevoflurane and 50% N2O. METHODS One hundred five ASA I and II patients were randomly allocated to receive an effect site concentration of remifentanil 2, 4, or 6 ng/ml. Trachea was intubated without muscle relaxant after 3 minutes of inhalation induction with 8 vol% sevoflurane and 50% N2O. The intubating conditions for tracheal intubation were assessed and blood pressure and heart rate were recorded at the baseline, before intubation, just after intubation, 1, and 3 minute after intubation. RESULTS Tracheal intubation was successful in all patients. Clinically acceptable intubation conditions were 60%, 94%, and 100% in 2 ng/ml, 4 ng/ml, and 6 ng/ml group respectively. However, the number of patient who requested rescue medication for bradycardia in 6 ng/ml group was significantly higher than that in the other group (P < 0.05). CONCLUSIONS We concluded that 4 ng/ml effect site concentration of remifentanil is adequate concentration for tracheal intubation without muscle relaxants during inhalation induction using sevoflurane.
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Affiliation(s)
- Hyun Jin Oh
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea.
| | - Yoon Hee Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea.
| | - Jung Un Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea.
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Kim MK, Lee JW, Jang DJ, Shin OY, Nam SB. Effect-site concentration of remifentanil for laryngeal mask airway insertion during target-controlled infusion of propofol. Anaesthesia 2009; 64:136-40. [PMID: 19143689 DOI: 10.1111/j.1365-2044.2008.05707.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to determine the effect-site concentration of remifentanil that would provide optimal conditions for successful laryngeal mask airway insertion during a target-controlled infusion (TCI) of propofol at 3.5 microg.ml(-1) without the use of neuromuscular blockade. Five minutes after propofol infusion, remifentanil was infused at a dose determined by a modified Dixon's up-and-down method. Five minutes after remifentanil infusion, the laryngeal mask was inserted. The effect-site concentration of remifentanil for successful laryngeal mask insertion in 50% of adults (EC(50)) was 3.04 (SD 0.49) ng.ml(-1) during a TCI of 3.5 microg.ml(-1) propofol without neuromuscular blockade. From the probit analysis, the EC(50) and EC(95) of remifentanil were 2.84 ng.ml(-1) (95% CI 2.09-3.57 ng.ml(-1)) and 3.79 ng.ml(-1) (95% CI 3.26-9.25 ng.ml(-1)), respectively.
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Affiliation(s)
- M K Kim
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
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Kim SJ, Yoo KY, Park BY, Kim WM, Jeong CW. Comparison of intubating conditions and hemodynamic responses to tracheal intubation with different effect-site concentrations of remifentanil without muscle relaxants during target-controlled infusion of propofol. Korean J Anesthesiol 2009; 57:13-19. [DOI: 10.4097/kjae.2009.57.1.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Seok Jai Kim
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Yeon Yoo
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Byoung Yun Park
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Woong Mo Kim
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Cheol Won Jeong
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
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Vetrugno L, Bassi F, Roccato A, Giordano F. It Is Nice to “Wake Up” Patients for Combined Carotid Endarterectomy and Coronary Artery Bypass Graft Surgery. J Cardiothorac Vasc Anesth 2008; 22:943-4; author reply 944-5. [DOI: 10.1053/j.jvca.2007.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Indexed: 11/11/2022]
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[Target-controlled infusion (TCI) - a concept with a future?: state-of-the-art, treatment recommendations and a look into the future]. Anaesthesist 2008; 57:223-30. [PMID: 18322665 DOI: 10.1007/s00101-008-1329-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Over the last 10 years the technique of target-controlled infusion (TCI) has substantially influenced the development and practice of intravenous anaesthesia. It opened the possibility of many new and exciting applications of perioperative anaesthetic care. More recent and current developments, such as open TCI (target-controlled infusion) and the availability of generic anaesthetic agents combined with modern infusion pumps, means that TCI can become a standard procedure in anaesthesia and is no longer just a research tool for specialists and enthusiasts. This review explains the fundamentals and applications of intravenous drug delivery by TCI and gives practice guidelines to successfully implement the technique into clinical practice. The aim is to provide a comprehensive reference based on clinically proven evidence.
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Remifentanil-TCI and propofol-TCI for conscious sedation during fibreoptic intubation in the acromegalic patient. Eur J Anaesthesiol 2008; 25:670-4. [PMID: 18400142 DOI: 10.1017/s0265021508004195] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the use of remifentanil-propofol administered as target-controlled infusion during awake fibreoptic intubation for anticipated difficult tracheal intubation in acromegalic patients. METHOD In all, 20 consecutive acromegalic patients underwent elective endonasal endoscopic transsphenoidal pituitary surgery. After premedication with midazolam 0.03 mg kg(-1), initially a target-controlled infusion of remifentanil 1.0 ng mL(-1) and propofol 1.5 microg mL(-1) was started. The fibreoptic intubation was performed by the same physician experienced with the fibreoptic technique. During the fibreoptic procedure the target concentrations of remifentanil and propofol ranged between 1.0 and 5.0 ng mL(-1), and between 1.5 and 3.5 microg mL(-1), respectively. Changes in heart rate and mean arterial pressure were recorded during airway manipulation, during tracheal intubation, and at 1 and 3 min after. On the first postoperative day, patient recall and level of discomfort during fibreoptic intubation were evaluated. RESULTS Endotracheal intubation was efficaciously and quickly secured in all patients. A significant increase in mean arterial pressure and heart rate was recorded only during tracheal intubation (P < 0.05). Oxygenation was sufficient and no bradypnea or apnoea was recorded. All patients later described their anaesthetic experience as satisfactory. During fibreoptic intubation, remifentanil (ng mL(-1)) and propofol (microg mL(-1)) mean effect-site concentrations were 3.2 +/- 0.3 and 2.0 +/- 1.0, respectively. CONCLUSION Remifentanil and propofol target-controlled infusion provided satisfactory conscious sedation allowing for successful oral fibreoptic intubation in acromegalic patients with no recall.
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