Background & Objectives: Endotracheal intubation is one of the most potent stimuli as an integral part of general anesthesia with several risks such as a sudden increase in blood pressure and pulse rate. One of the drugs that can be used to prevent hemodynamic spikes in endotracheal intubation is remifentanil. It has rapid onset and peak effect with short duration of action. Various authors have used different doses of this drug. We compared the effect of two different doses of remifentanil on hemodynamic response to endotracheal intubation. Methodology: It was a randomized clinical trial on 35 patients, aged 19-65 y, physical status ASA I-II, body mass index (BMI) 18.5-29.99 kg/m2, who underwent elective surgery under general anesthesia. Subjects were randomly assigned into 2 groups, Group R1, who received remifentanil 0.5 µg/kg intravenously (IV), followed by an infusion @ 0.1 µg/kg/min; and Group R2, who received remifentanil 1 µg/kg followed by 0.1 µg/kg/min intravenously. Systolic, diastolic and mean arterial pressure, and pulse rates were noted on arrival in the operating room T0, then measurements were performed 2 min after induction (T1), 1 min after intubation (T2), and continued at 3 and 5 min after intubation (T3 and T4). The data was analyzed with SPSS v21.0 for Windows. T-test or Mann-Whitney U test was performed to analyze the data. Results: Based on this study, the hemodynamic parameters were significantly lower in systolic blood pressure (113.35 ± 4.66 vs. 107.83 ± 6.37, P = 0.008), diastolic blood pressure (68.88   vs. 61.83  P = 0.004), mean arterial pressure (83.76  vs. 77.28 ± 5.84, P = 0.001) and pulse rate (83.71 ± 8.20 vs. 76.11 ± 9.70, P = 0.013) after 1 min of endotracheal intubation in the remifentanil 1 µg/kg group compared to the 0.5 µg/kg remifentanil group. Conclusion: Administration of remifentanil 1 µg/kg followed by maintenance of 0.1 g/kg/min can cause a statistically significant decrease in blood pressure and heart rate compared to remifentanil 0.5 µg/kg followed by maintenance of 0.1 µg/kg/min, when administered for endotracheal intubation. Abbreviation: BMI: body mass index; IV: intravenously; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; MBP: Mean arterial blood pressure; Key words: Endotracheal intubation; Hemodynamic insult; Remifentanil Citation: Suwarman, Prihartono MA, Azhari GA. Comparison of two different doses of intravenous remifentanil on cardiovascular response to endotracheal intubation: a randomized controlled trial. Anaesth. pain intensive care 2022;26(6):778−783; DOI: 10.35975/apic.v26i6.2047

Introduction: Patients with congenital heart disease especially with systemic shunting between systemic and pulmonary circulation often develop pulmonary hypertension and left-to-right shunt (Eisenmenger syndrome) if left untreated. These patients are at risk of developing spontaneous brain abscess due to brain infarction caused by polycythemia, impaired immune function, and loss of lung phagocytosis. Such patients were often admitted to the emergency room with signs of increased intracranial pressure (ICP), and needed specific consideration during surgery. Case: a 31-year old female diagnosed with intracranial space occupying lesion (SOL) due to suspected brain abscess with concurrent heart defects (atrial septal defect / ASD and Eisenmenger syndrome) was consulted to the operating theatre for emergency burrhole aspiration. The surgery was performed for an hour and the postoperatively the patient was admitted to the intensive care unit (ICU). Conclusion: perioperative management of patients with brain abscess and concurrent ASD and Eisenmenger syndrome consists of preoperative management, methods of anesthesia, monitoring, and interventions to prevent the worsening of left-to-right shunt and increasing intracranial pressure. These managements consist of optimal pain management, perioperative oxygen therapy, and prevention of precipitating factor that increases left-to-right shunting.

Introduction: Patients with congenital heart disease especially with systemic shunting between systemic and pulmonary circulation often develop pulmonary hypertension and left-to-right shunt (Eisenmenger syndrome) if left untreated. These patients are at risk of developing spontaneous brain abscess due to brain infarction caused by polycythemia, impaired immune function, and loss of lung phagocytosis. Such patients were often admitted to the emergency room with signs of increased intracranial pressure (ICP), and needed specific consideration during surgery. Case: a 31-year old female diagnosed with intracranial space occupying lesion (SOL) due to suspected brain abscess with concurrent heart defects (atrial septal defect / ASD and Eisenmenger syndrome) was consulted to the operating theatre for emergency burrhole aspiration. The surgery was performed for an hour and the postoperatively the patient was admitted to the intensive care unit (ICU). Conclusion: perioperative management of patients with brain abscess and concurrent ASD and Eisenmenger syndrome consists of preoperative management, methods of anesthesia, monitoring, and interventions to prevent the worsening of left-to-right shunt and increasing intracranial pressure. These managements consist of optimal pain management, perioperative oxygen therapy, and prevention of precipitating factor that increases left-to-right shunting.