Comparison of effects of remifentanil and alfentanil on cardiovascular response to tracheal intubation in hypertensive patients

Maguire, A.M.; Kumar, Naveen; Parker, Jim; Rowbotham, D. J.; Thompson, Jonathan P.

doi:10.1093/bja/86.1.90

Cited by 80 publications

(45 citation statements)

References 16 publications

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“…A variety of interventions [1][2][3][4][5][6] have been examined as possible stabilisers of the cardiovascular response, but none of these interventions have resulted in stable induction of anaesthesia because of either the inadequacy of their effect or unwanted sideeffects. It would be of great help if we could predict the haemodynamic response to induction of general anaesthesia.…”

mentioning

confidence: 99%

Correlation between heart rate variability and haemodynamic fluctuation during induction of general anaesthesia: comparison between linear and non‐linear analysis*

et al. 2007

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SummaryThe objective of this study was to compare linear and non-linear analysis of heart rate variability (HRV) in terms of correlation with haemodynamic fluctuation during induction of general anaesthesia. Pre-operatively, HRV was estimated by the MemCalc method in 114 patients scheduled for general anaesthesia. After anaesthesia was induced with propofol, fentanyl and vecuronium bromide, tracheal intubation was performed. Haemodynamic fluctuations during induction of anaesthesia were recorded and the correlation between pre-operative HRV and haemodynamic fluctuation was examined using logistic regression analysis. As an index of non-linear analysis of HRV, ultra short-term entropy (UsEn) correlated better with blood pressure fluctuation than did the ratio of the power of low frequency component of HRV to that of high frequency component (LF ⁄ HF). In contrast, although LF ⁄ HF significantly correlated with heart rate increase caused by tracheal intubation, the correlation between UsEn and heart rate fluctuation was not significant. Recently, some investigators have found linear analysis of heart rate variability (HRV) to predict the incidence of hypotension caused by induction of general [7] or spinal anaesthesia [8,9]. While frequency-domain measures of HRV, such as spectral analysis, focus on the status of cardiac autonomic activity, it is proposed that non-linear indices may provide insight into the overall structure of the heart rate regulating system. Although it was reported that pre-operative point dimension correlation (PD2), as a non-linear index of HRV, predicted hypotension after spinal anaesthesia [10], there is no previous report examining the correlation between non-linear index of HRV and circulatory response to induction of general anaesthesia.The MemCalc method, which is a combination of the maximum entropy method for spectral analysis and the non-linear least squares method for fitting analysis (Tarawa, Suwa Trust, Tokyo, Japan), has recently been developed [11,12]. This method enables us to estimate reliable HRV from a series of RR intervals over 30 s and recognises the abnormal RR interval of premature beats or artefacts, including noise, and removes it automatically. The MemCalc method does not cause distortion of the power calculation even if the underlying variation is changed, e.g. a change in respiration. When compared to

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mentioning

confidence: 99%

Correlation between heart rate variability and haemodynamic fluctuation during induction of general anaesthesia: comparison between linear and non‐linear analysis*

et al. 2007

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“…Most reports concerning the pressure response to tracheal intubation in the presence of remifentanil used a bolus dose of propofol [8][9][10][11][12][13] or bolus followed by continuous infusion of remifentanil [14][15][16]. Miyake and colleagues demonstrated that continuous administration of remifentanil 0.5 μg/kg/min with midazolam 0.2 mg/kg suppressed the pressure responses to tracheal intubation compared with remifentanil 0.1 and 0.2 μg/kg/min [17] There were no significant differences in mean arterial pressure between continuous infusion of remifentanil 0.5 μg/kg/min following a bolus dose of remifentanil 1 μg/kg and 0.25 μg/kg/min following a bolus dose of 0.5 μg/kg.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Hemodynamic Responses Associated with Tracheal Intubation Under Various Induction Doses of Remifentanil and Propofol

Goyagi¹,

Yoshimoto²

2012

OJAnes

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Background: The optimal dose of propofol and remifentanil induction to minimize the cardiovascular response associated with tracheal intubation may exist. We investigated the cardiovascular response associated with tracheal intubation when various continuous induction doses of remifentanil in combination with propofol were used. Methods: Seventyfive patients were randomly allocated into 1 of 3 groups: the R-0.4 P-1 group (remifentanil 0.4 μg/kg/min and propofol 1 mg/kg); the R-0.5 P-1 group (remifentanil 0.5 μg/kg/min and propofol 1 mg/kg); and the R-0.4 P-2 group (remifentanil 0.4 μg/kg/min and propofol 2 mg/kg). One minute after remifentanil infusion commenced, a bolus of propofol was injected. Rocuronium 1 mg/kg was administered 1 min after propofol injection following loss of consciousness. Controlled ventilation was then performed for 2 min, and the trachea was intubated 4 min after the start of the remifentanil infusion. The infusion rate of remifentanil was decreased to 0.1 μg/kg/min after intubation. Blood pressure (BP) and heart rate (HR) were measured during this period until 5 min after tracheal intubation. Results: The changes in BP response due to tracheal intubation in the R-0.4 P-1 group were greater than those in the other 2 groups, whereas the HR responses to tracheal intubation were similar among the 3 groups. Conclusion: The combination of remifentanil 0.4 μg/kg/min and propofol 1 mg/kg led to an exaggerated cardiovascular response to tracheal intubation compared with the other combination groups.

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“…predicted concentration around 3 ng/ml) already induced hypotension in 7/20 hypertensive patients (Maguire et al 2001).…”

Section: Induction and Airway Controlmentioning

confidence: 91%

Remifentanil and Other Opioids

Servin

Billard

Handbook of Experimental Pharmacology

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Most opioids used in anaesthesia are of the anilidopiperidine family, including fentanyl, alfentanil, sufentanil and remifentanil. While all share similar pharmacological properties, remifentanil, the newest one, is probably the most original, which is the reason this review focusses especially on this drug. Remifentanil is a potent mu-agonist that retains all the pharmacodynamic characteristics of its class (regarding analgesia, respiratory depression, muscle rigidity, nausea and vomiting, pruritus, etc.) but with a unique pharmacokinetic profile that combines a short onset and the fastest offset, independent of the infusion duration. Consequently, it offers a unique titratability when its effects need to be quickly achieved or suppressed, but it requires specific drug delivery schemes such as continuous infusion, target-controlled infusion and anticipated postoperative pain treatment. Kinetic differences between opioids used in anaesthesia and some clinical uses of remifentanil are reviewed in this chapter.

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Comparison of effects of remifentanil and alfentanil on cardiovascular response to tracheal intubation in hypertensive patients

Cited by 80 publications

References 16 publications

Correlation between heart rate variability and haemodynamic fluctuation during induction of general anaesthesia: comparison between linear and non‐linear analysis*

Correlation between heart rate variability and haemodynamic fluctuation during induction of general anaesthesia: comparison between linear and non‐linear analysis*

Comparison of Hemodynamic Responses Associated with Tracheal Intubation Under Various Induction Doses of Remifentanil and Propofol

Remifentanil and Other Opioids

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