Desflurane–remifentanil–nitrous oxide anaesthesia for abdominal surgery: optimal concentrations and recovery features

Billard, V.; Servin, Frédérique; Guignard, B.; Junke, E.; Bouverne, Marie-Noëlle; Hédouin, M; Chauvin, M.

doi:10.1111/j.0001-5172.2004.0324.x

Cited by 15 publications

(9 citation statements)

References 38 publications

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“…In the current study, the duration of anesthesia and the duration of surgery were 80,9 and 60,4 min, respectively. The data obtained from this study seems to be compatible with other similar studies in literature [5].…”

Section: Discussionsupporting

confidence: 93%

General anesthesia management in 15 preterm infant undergoing diode laser photocoagulation for retinopathy of prematurity: a retrospective study

Özkan¹,

Akbaş²,

Polat³

2017

Med-Science

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Anesthesia management of preterm infants is challenging for the anesthesiologist. Because of the rudimentary build of the infants, many medical and physical problems have been observed in the treatment of the disease such as complications, airway problems, temperature disregulation and deficient drug metabolism. This retrospective study evaluates the perioperative management and postoperative course in premature infants undergoing diode laser photocoagulation (DLP) for retinopathy of prematurity (ROP). We analyzed the preoperative data, anesthesia chart, and postoperative course of 15 preterm infants for general anesthesia exposures for ROP surgery. Minimum weight and gestational age at birth were 480 g and 23 weeks, respectively. Mean value of weight at birth was less than 1000 g (886,3g) differently from other studies. The mean anesthesia and surgery duration were 80,9 and 60,4 min, respectively. Paracetamol was implemented for postoperative analgesia through rectal route in 5 infants and intravenous route in 10 infants at the start of surgery. Eleven patients were extubated in the operating room and 4 infants were extubated in the following days. Birth weights of infants were between 480 and 1240 g. Supraglottic airway such as I-gel was applied in 5 infants, laryngeal mask airway (LMA) in 5 infants and endotracheal intubation (ETI) was applied in 4 infants. In the present study, we found that intraoperative complications, duration of anesthesia and surgery were acceptable and similar to those of other studies. However, the value of apnea in current study was less significant when compared to other studies,which can be correlated with intubation without muscle relaxant or post-conceptual age over 35 weeks.

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Section: Discussionsupporting

confidence: 93%

General anesthesia management in 15 preterm infant undergoing diode laser photocoagulation for retinopathy of prematurity: a retrospective study

Özkan¹,

Akbaş²,

Polat³

2017

Med-Science

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“…However, the shortening of the LOC time in the patients who received more remifentanil, according to the opioid-volatile synergy on hypnosis [23], was not revealed in this study. This might be due to the weak influence of the combined opioid on hypnosis with a ceiling effect at lower concentrations [17,24]. The small sample size of this up-and-down study might also have been responsible for this.…”

Section: Discussionmentioning

confidence: 99%

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

Lee

Jung

2011

Korean J Anesthesiol

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BackgroundAnesthesia induction with desflurane is troublesome because of the frequent sympathetic hyperactivity during desflurane administration. We thought that a low concentration of desflurane combined with a target-controlled infusion (TCI) of remifentanil would eliminate the desflurane-related complications and provide hemodynamic stability during desflurane induction. An up-and-down study was planned to find the target effect-site concentration of remifentanil to block the hemodynamic response to endotracheal intubation, the highest level of stimulus, during anesthesia induction with administering desflurane at 1 MAC.MethodsRemifentanil TCI was initiated before desflurane administration. When the preset target was achieved, spontaneous inhalation of desflurane 1 MAC was performed until the patients became unconscious. Laryngoscopic tracheal intubation was facilitated with rocuronium injection. The starting concentration of remifentanil and the test space were 5 and 1 ng/ml, respectively. The criteria for up-and-down was a 20% increase of the mean arterial pressure or heart rate after intubation. The median effective concentration (EC50) of remifentanil was calculated from 6 independent pairs. The complications related with remifentanil and desflurane were assessed during the study.ResultsWe studied 20 patients using 2-5 ng/ml of the effect-site concentrations of remifentanil. The EC50 of remifentanil was 3.7 ng/ml. Loss of consciousness was achieved at 125 ± 22 s after desflurane inhalation and this was irrespective of the combined remifentanil concentrations. Any remifentanil-related complication was not observed. Transient cough was seen in one patient who received 2 ng/ml of remifentanil.ConclusionsWe demonstrated that uncomplicated induction with desflurane was possible by the use of target-controlled remifentanil. The EC50 of remifentanil to block the hemodynamic response to tracheal intubation was 3.7 ng/ml during inhalational induction with 1 MAC desflurane.

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“…Target concentrations exceeding 8 ng/ml are necessary to completely blunt the BP and HR response when compared to pre-intubation values (Guignard et al 2000b), but they result in prolonged reduction in arterial pressure. Target concentrations of 5-7 ng/ml appear as a good compromise to maintain BP and HR response around the pre-induction values (Billard et al 2004). A single bolus of 1 µg/kg induces only a moderate HR increase (McAtamney et al 1998).…”

Section: Induction and Airway Controlmentioning

confidence: 97%

“…Such an effect is not unheard of, and similar findings have already been published with fentanyl (Chia et al 1999) and alfentanil (Kissin et al 1996;Mandema and Wada 1995). Nevertheless, this acute tolerance to remifentanil has not always been demonstrated in the clinical setting (Billard et al 2004;Cortinez et al 2001;Schraag et al 1999). Schraag et al administered remifentanil as a TCI for postoperative pain and could not demonstrate any increase in effective remifentanil concentrations over time (Cortinez et al 2001;Schraag et al 1999).…”

Section: Remifentanil and Acute Tolerancementioning

confidence: 99%

“…For example, intubation is a stronger stimulus than laryngoscopy, which in turn is stronger than skin incision. Intra-abdominal surgery represents a very strong stimulus and requires remifentanil concentrations between 4 and 10 ng/ml (Billard et al 2004;Dershwitz et al 1995). Other particular contexts will be described below.…”

Section: Control Over Intra-operative Stimulimentioning

confidence: 99%

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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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Desflurane–remifentanil–nitrous oxide anaesthesia for abdominal surgery: optimal concentrations and recovery features

Cited by 15 publications

References 38 publications

General anesthesia management in 15 preterm infant undergoing diode laser photocoagulation for retinopathy of prematurity: a retrospective study

General anesthesia management in 15 preterm infant undergoing diode laser photocoagulation for retinopathy of prematurity: a retrospective study

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

Remifentanil and Other Opioids

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