Comparison of the effect of continuous intravenous infusion and two bolus injections of remifentanil on haemodynamic responses during anaesthesia induction: a prospective randomised single-centre study

Abstract

BackgroundRemifentanil is an effective drug for protecting against adverse haemodynamic responses to tracheal intubation. We compared the haemodynamic responses during anaesthesia induction between continuous intravenous (IV) infusion and two bolus injections of remifentanil.MethodsThis prospective, randomised, open-label, single-centre study included patients with American Society of Anesthesiologists physical status I-II, scheduled to undergo elective surgery under general anaesthesia. Patients were randomised into two groups based on remifentanil administration type: the continuous IV infusion group (Group C) receiving a 0.3-μg/kg/min remifentanil infusion for 5 min followed by a 0.1-μg/kg/min remifentanil infusion, and the IV bolus group (Group B) receiving a combination of two bolus injections of remifentanil (first bolus of 0.4 μg/kg and second bolus of 0.6 μg/kg after 3 min) and 0.1 μg/kg/min remifentanil. General anaesthesia was induced with 1 mg/kg propofol and 0.6 mg/kg rocuronium 3 min after remifentanil infusion (Group C) or immediately after the first bolus of remifentanil (Group B). Tracheal intubation was performed 4 min after the injection of propofol and rocuronium. Heart rate and non-invasive blood pressure were recorded at 1-min intervals from baseline (i.e., before induction) to 5 min after tracheal intubation.ResultsA total of 107 patients were enrolled (Group C, 55; Group B, 52). Normotensive patients with no history of antihypertensive medication use were assigned to the normotensive subgroup (41 each in both groups), while those with hypertension but without a history of antihypertensive medication use were assigned to the untreated hypertensive subgroup (Group C vs. B, n = 7 vs. 4). Finally, patients with a history of antihypertensive medication use were assigned to the treated hypertensive subgroup (7 each in both Groups C and B). No differences in heart rate and blood pressure were observed between Groups C and B within each subgroup.ConclusionsHaemodynamic responses during anaesthesia induction were similar between continuous infusion and two bolus injections of remifentanil within both normotensive and hypertensive patients with or without medication.Trial registrationThe trial was retrospectively registered with Japanese Clinical Trial Registry “UMIN-CTR” on 20 October 2016 and was given a trial ID number UMIN000024495.

The use of remifentanil in critically ill patients undergoing percutaneous dilatational tracheostomy: A prospective randomized‐controlled trial

“…A significant drop of SBP during T2 stage illustrates a huge influence of remifentanil to hemodynamics, and the influence lasts to stage T3. This is in line with Toyoaki et al and Park et al's researches where BP is significantly decreased from baseline after anesthesia induction with remifentanil . We give a rapid infusion of normal saline to increase the SBP and there are no differences of SBP in the stage T4 and T5.…”

Effect of remifentanil infusion on the hemodynamic response during induction of anesthesia in hypertensive and normotensive patients: a prospective observational study

“…3,4 Another possible reason for the greater reduction in blood pressure that was observed in our study could be because of the relatively low volume of intravenous fluid loading we used before induction. Maruta et al 13 compared the effect of a continuous infusion with bolus administration of remifentanil and evaluated the reason in treated and untreated subgroups of hypertensive patients. They reported that a continuous infusion of remifentanil in contrast to bolus administration maintained baseline blood pressures for a prolonged duration after intubation in hypertensive patients, regardless of antihypertensive drug administration.…”

“…Third, the effect-site concentration (concentration of drug at the site of its biological activity) of remifentanil cannot be measured accurately. Maruta et al 13 calculated the effect-site concentrations of remifentanil based on a default formula from the electronic anesthesia record. We did not use a default program or a targetcontrolled infusion system; thus, it was not possible to estimate the effect-site concentration of remifentanil.…”

“…[8][9][10] In adult patients, administration of remifentanil (1 mg/kg) during induction of anesthesia has been shown to reduce the hemodynamic response to intubation. [10][11][12] Maruta et al 13 reported that bolus doses or a continuous infusion of remifentanil that attenuated the hemodynamic response was similar in both normotensive and hypertensive patients with or without the use of antihypertensive medication. However, no large-scale study has been performed to evaluate the differences in the hemodynamic response during induction of general anesthesia between normotensive and hypertensive patients.…”

Perioperative systemic magnesium sulphate to minimize acute and chronic post-thoracotomy pain: a prospective observational study

“…The etiology of CPTP is not fully understood, but many patients experiencing CPTP have neuropathic pain rather than nociceptive pain (10). In chronic pain states, an inappropriate focus can be made of pain intensity.…”