Effect‐site concentration of remifentanil attenuating surgical stress index responses to intubation of the trachea

Mustola, Seppo; Toivonen, Juhani

doi:10.1111/j.1365-2044.2010.06329.x

Cited by 8 publications

(10 citation statements)

References 20 publications

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“…There are many studies related to propofol-remifentanil TCI induction methods to suppress hemodynamic instability [13][14][15]. Albertin et al [13] suggested that EC50 of remifentanil during intubation is 5.0 ng/mL (95% CI, 4.7-5.4 ng/mL) while using Ce of propofol 4 µg/mL, which is similar to the results of our study in group PRO 3.5.…”

Section: Resultssupporting

confidence: 87%

“…Albertin et al [13] suggested that EC50 of remifentanil during intubation is 5.0 ng/mL (95% CI, 4.7-5.4 ng/mL) while using Ce of propofol 4 µg/mL, which is similar to the results of our study in group PRO 3.5. Mustola and Toivonen [14] suggested that EC50 and EC95 of remifentanil is 3.17 ng/mL and 3.79 ng/mL, respectively, during intubation while using Ce of propofol 4 µg/mL, and this study showed lower Ce compared with our group PRO 3.5. Troy et al [15] consider that a Ce of remifentanil 8 ng/mL along with a Ce of propofol 3 µg/mL may provide satisfactory conditions for intubation while avoiding major adverse effect, compared with our study in group PRO 3.5 in which EC95 was 5.42 ng/mL (95% CI, 5.13-7.47 ng/mL), showing a higher Ce.…”

Section: Resultssupporting

confidence: 41%

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Increased Effect-Site Concentration of Propofol Reduces EC<sub>50</sub> of Remifentanil for Successful Intubation Using the Shikani Optical Stylet without Neuromuscular Blockade

Cho

Lee

Park

et al. 2019

Soonchunhyang Med Sci

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Objective: For short-duration surgery, propofol and remifentanil are the drugs of choice for intubation without neuromuscular blockade. The Shikani Optical Stylet (SOS) is a novel semi-rigid type fiberoptic laryngoscope. In this study, we determined the clinically required effect-site concentration of remifentanil for intubation using SOS without neuromuscular blockade depending on propofol effect-site concentration. Methods: We enrolled patients scheduled for elective surgery with general anesthesia, and assigned them into two groups by a randomized, double-blind method: concentration of propofol 3.5 µg/mL (group PRO 3.5) and 7.0 µg/mL (group PRO 7.0). Anesthesia was conducted with target-controlled infusion in predetermined target effect-site concentrations of propofol. The concentration of remifentanil for successful intubation using SOS in 50% of patients (EC50) was determined using a modified Dixon's up-anddown method. Results: The mean± standard deviation EC50 of remifentanil was 5.07± 0.40 ng/mL in group PRO 3.5 and 1.79± 0.44 ng/mL in group PRO 7.0. From probit analysis, EC50 and EC95 of remifentanil in group PRO 3.5 were 4.85 ng/mL (95% confidence interval [CI], 4.44-5.16 ng/mL) and 5.42 ng/mL (95% CI, 5.13-7.47 ng/mL) respectively, and EC50 and EC95 of remifentanil in group PRO 7.0 were 1.68 ng/mL (95% CI, 1.22-2.01 ng/mL) and 2.29 ng/mL (95% CI, 1.98-4.05 ng/mL), respectively. Conclusion: Increased concentration of propofol reduced EC50 of remifentanil for successful intubation using SOS without neuromuscular blockade.

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Section: Resultssupporting

confidence: 87%

Section: Resultssupporting

confidence: 41%

Increased Effect-Site Concentration of Propofol Reduces EC<sub>50</sub> of Remifentanil for Successful Intubation Using the Shikani Optical Stylet without Neuromuscular Blockade

Cho

Lee

Park

et al. 2019

Soonchunhyang Med Sci

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“…From these values, it generates a number on a linear scale (0–100), where values exceeding 50 are thought to represent pain. Most current research has investigated its ability to aid titration of intra‐operative remifentanil this response to noxious stimulation . Although pre‐clinical and clinical (intra‐operative and postoperative) research indicated its ability to discriminate strong noxious stimuli from no stimulation , the method could not consistently differentiate stimulus intensities .…”

Section: Resultsmentioning

confidence: 99%

Assessing pain objectively: the use of physiological markers

et al. 2015

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Summary Pain diagnosis and management would benefit from the development of objective markers of nociception and pain. Current research addressing this issue has focused on five main strategies, each with its own advantages and disadvantages. These encompass: (i) monitoring changes in the autonomic nervous system; (ii) biopotentials; (iii) neuroimaging; (iv) biological (bio‐) markers; and (v) composite algorithms. Although each strategy has shown areas of promise, there are currently no validated objective markers of nociception or pain that can be recommended for clinical use. This article introduces the most important developments in the field and highlights shortcomings, with the aim of allowing the reader to make informed decisions about what trends to watch in the future.

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“…Monitoring depth of analgesia is an on going challenge for anaesthetists [16, 17], and the SPI is a recent development in this field. Previously published data show that the variables measured by the SPI, namely the normalised heart beat interval and the pulse plethysmographic amplitude, are indeed capable of detecting noxious stimuli representing nociception [3], and are affected by analgesia representing anti‐nociception [4, 18, 19]. Apart from nociception, however, many other factors such as hypovolaemia, catecholamine levels, drugs affecting heart rate [10] and position may contribute to a patient`s ‘surgical stress’ and affect the surrogate variables measured by the SPI.…”

Section: Discussionmentioning

confidence: 99%

The effect of posture and anaesthetic technique on the surgical pleth index

Ilies¹,

Ludwigs

Gruenewald³

et al. 2012

Anaesthesia

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SummaryThe surgical pleth index has been shown to correlate with surrogate variables of nociception during general anaesthesia, and it has been suggested to be of use as a depth of anaesthesia monitor. However, little is known about confounding factors. As the main determining variables are based on both central and peripheral autonomic regulatory mechanisms, we hypothesised that changing a patient's posture may produce a marked effect. We studied the effects of posture change in 45 patients who were randomly assigned to receive general (n = 15) or spinal anaesthesia with (n = 15) or without sedation (n = 15), as well as 15 awake volunteers. Mean (SD) values of the surgical pleth index after adoption of the lithotomy position were reduced from 57 (22) to 21 (6) under general anaesthesia, 63 (15) to 31 (9) under spinal anaesthesia alone, and 52 (14) to 22 (8) under spinal anaesthesia with sedation (all p < 0.01). In healthy volunteers, the surgical pleth index increased from 37 (13) to 57 (11) (p < 0.01) after 30°head-up tilt and was reduced from 35 (11) to 25 (11) after head-down tilt (p < 0.05). Change in posture has a marked effect on the surgical pleth index which lasts for at least 45 min, and this must be considered when interpreting the displayed values. The surgical pleth index (SPI) (formerly known as the surgical stress index, GE Healthcare, Helsinki, Finland) was developed as a tool to quantify the physiological reactions caused by nociception during general anaesthesia, and consists of a combined measurement of central (normalised heart beat interval) and peripheral (plethysmographic pulse wave amplitude) sympathetic tone. A more detailed description of the underlying algorithm has been published previously [1]. Several studies have investigated its performance during general anaesthesia [2][3][4][5][6], general anaesthesia combined with regional anaesthesia [7], emergence from anaesthesia [8] and spinal anaesthesia with and without sedation [9]. A number of confounding factors have already been demonstrated, including atropine administration, cardiac pacing [10], level of sedation [9] and intravascular volume status [11]. The SPI ranges from 0 to 100, and a high value is claimed to be associated with a high stress level. The optimal range has not yet been determined, but a SPI of 50 is supposed to reflect a mean stress level, with nociceptive and anti-nociceptive factors balanced.It is well known that changes in patients' position can lead to changes in the balance of the autonomic nervous system, and the tilt-table test is an accepted method of assessing the interplay between the sympathetic and parasympathetic branches of the autonomic nervous

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Effect‐site concentration of remifentanil attenuating surgical stress index responses to intubation of the trachea

Cited by 8 publications

References 20 publications

Increased Effect-Site Concentration of Propofol Reduces EC<sub>50</sub> of Remifentanil for Successful Intubation Using the Shikani Optical Stylet without Neuromuscular Blockade

Increased Effect-Site Concentration of Propofol Reduces EC<sub>50</sub> of Remifentanil for Successful Intubation Using the Shikani Optical Stylet without Neuromuscular Blockade

Assessing pain objectively: the use of physiological markers

The effect of posture and anaesthetic technique on the surgical pleth index

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