The Effect of Fentanyl on Sevoflurane Requirements for Somatic and Sympathetic Responses to Surgical Incision

Katoh, Takasumi; Kobayashi, Shunji; Suzuki, Akira; Iwamoto, Takeaki; Bito, Hiromichi; Ikeda, Kazuyuki

doi:10.1097/00000542-199902000-00012

Cited by 145 publications

(66 citation statements)

References 23 publications

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“…18 In contrast to somatic reflexes however, hemodynamic responses to noxious stimuli do not correlate well with end-tidal drug concentration. 19 It is for the above reasons that the effects of remifentanil on MAC of sevoflurane and not MAC-BAR of sevoflurane were studied.…”

Section: Discussionmentioning

confidence: 95%

Remifentanil decreases sevoflurane requirements in children

Castanelli

Splinter

Clavel

2005

Can J Anesth/J Can Anesth

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Purpose:To establish the effect of increasing concentrations of remifentanil on sevoflurane requirements in children.Methods: Fifty-eight healthy patients, ASA status I-II aged two to 12 yr, undergoing abdominal wall hernia or hydrocele repairs were serially assigned to one of four test groups to receive remifentanil 0.03 µg·kg -1 ·min -1 , 0.06 µg·kg -1 ·min -1 , 0.12 µg·kg -1 ·min -1 , or 0.25 µg·kg -1 ·min -1 iv. Patients received a bolus of remifentanil 1 µg·kg -1 iv before the infusion began. End-tidal sevoflurane concentration was adjusted according to a Dixon up-and-down approach. Ten minutes after starting the remifentanil infusion, the surgical incision was made. The patient was observed for one minute from the time of incision by a solitary blinded rater for either flexion or withdrawal of one or more extremities in response to skin incision. Results:The mean minimum alveolar concentration of sevoflurane was 2.39 ± 0.58 with 0.03 µg·kg -1 ·min -1 remifentanil, 1.91 ± 0.36 with 0.06 µg·kg -1 ·min -1 remifentanil, and 0.92 ± 0.11 with 0.12 µg·kg -1 ·min -1 remifentanil. Remifentanil 0.25 µg·kg -1 ·min -1 lead to the sevoflurane being decreased to a level associated with spontaneous patient awakening.The effective dose (ED 50 ) values of sevoflurane were 2.44 [95% confidence interval (CI) 2.16-2.72], 2.00 (95% CI 1.78-2.22), and 1.18 (95% CI 0.99-1.36) for remifentanil infusion rates of 0.03 µg·kg -1 ·min -1 , 0.06 µg·kg -1 ·min -1 , and 0.12 µg·kg -1 ·min -1 respectively. Conclusion:The administration of remifentanil produced a dose-dependent decrease in the minimum alveolar concentration of sevoflurane necessary for inhibition of movement reaction in response to surgical incision. The use of remifentanil may allow for flexible analgesic control and rapid recovery in children anesthetized with sevoflurane. (IC de 95 % 1,22) et 1,18 (IC de 95 % 0,36) Objectif

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Section: Discussionmentioning

confidence: 95%

Remifentanil decreases sevoflurane requirements in children

Castanelli

Splinter

Clavel

2005

Can J Anesth/J Can Anesth

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“…A composition of gender in dogs is a great difference in experimental protocol between the present study (all intact female dogs) and the study reported by Love et al [14] (all intact male dogs). Gender difference in the MAC-BAR was supposed in human patients [11,24]. Further investigation is necessary to confirm the effect of gender on the MAC-BAR in dogs.…”

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confidence: 95%

“…The value of ratio of MAC-BAR/MAC is quite disparate between volatile anesthetic agents and species. It is reported that the ratio of MAC-BAR/MAC was 2.24 MAC for sevoflurane in human [11], 2.64 MAC for isoflurane in goats [1], 1.11 MAC for isoflurane in cats [15] and 1.48 MAC for halothane in cats [21]. Differences in study design, species, age, and volatile anesthetic agents may account for variability in MAC-BAR and MAC results.…”

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confidence: 99%

Minimum Alveolar Concentration for Blunting Adrenergic Responses (MAC-BAR) of Sevoflurane in Dogs

et al. 2012

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ABSTRACT. It is well known that heart rate or arterial blood pressure may increase in response to surgical stimulation despite the absence of a purposeful movement. However, there is limited information regarding anesthetic requirement for blunting adrenergic response in dogs. This study was designed to compare the minimum alveolar concentrations of sevoflurane required to prevent autonomic response (MAC-BAR) and purposeful movement (MAC) in dogs. Sevoflurane MAC-BAR and MAC were determined in 5 beagle dogs by judging dogs' response to a noxious electrical stimulus applied to the gingiva. The sevoflurane MAC-BAR was significantly higher than MAC (3.33 ± 0.48 vs 2.10 ± 0.28%, P=0.005). These results suggested that autonomic responses occurred at sevoflurane anesthetic concentrations at which purposeful movements were absent.

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“…32,33 The concept of general balanced anesthesia is defined by the co-administration of several pharmacological agents, so as to enhance their beneficial effects while reducing the side effects of individual drugs administered in high doses. 34 Clinical studies have reported that the reduction of intraoperative opioid doses is associated with diminished postoperative pain and reduced morphine consumption. 10,11 In the present study, repeated fentanyl administrations every 15 min (4 9 60 lg kg -1 ) on D 0 induced an early (lasting 4 h) and delayed and long-lasting hyperalgesia (lasting 3 days).…”

Section: Discussionmentioning

confidence: 99%

Effects of sevoflurane on carrageenan- and fentanyl-induced pain hypersensitivity in Sprague-Dawley rats

Richebé

Rivalan

Rivat

et al. 2008

Can J Anesth/J Can Anesth

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Purpose Opioids are widely used for anesthesia but paradoxically induce postoperative pain hypersensitivity via N-methyl-D-aspartate (NMDA) receptor modulation. Sevoflurane effects on opioid-induced hyperalgesia have not been yet evaluated in vivo. Nevertheless, some experimental in vitro studies reported anti-NMDA receptor properties for sevoflurane. The aim of this study was to evaluate sevoflurane effects on fentanyl-induced hyperalgesia in opioid-naive rats and in rats with inflammatory pain. Methods Sevoflurane effects on hyperalgesia were evaluated in Sprague-Dawley rats: opioid-naive rats, rats treated with fentanyl (4 9 60 lg kg -1 ) and rats with inflammatory pain (carrageenan) treated with fentanyl (4 9 60 lg kg -1 ). On day zero, subcutaneous fentanyl injections were administered and inflammatory pain was induced with one carrageenan injection in one hind paw. Rats were exposed to low concentrations of sevoflurane (1.0 or 1.5%) on day zero prior to fentanyl injections and inflammatory pain induction, and for the duration of the fentanyl analgesic effect. The nociceptive threshold (Randall-Selitto test) was evaluated daily for 7 days. On day seven, naloxone was injected and the nociceptive threshold was assessed 5 min later. Results In rats without inflammatory pain but treated with fentanyl on day zero, sevoflurane 1.0% reversed the early (day zero) and long-lasting (day zero to day three) hyperalgesia classically described after high-doses of fentanyl (P \ 0.05). This sevoflurane concentration antagonized the hyperalgesia induced by naloxone on day seven (P = 0.33). In a second experiment in rats with inflammatory pain, exposure to low concentrations of sevoflurane (1.0 and 1.5%) did not reduce fentanyl-induced hyperalgesia (P [ 0.05), but nevertheless antagonized the naloxone induced hyperalgesia on day seven (P = 0.061). Conclusion Relatively low sevoflurane concentrations (1.0%) reverse fentanyl-induced hyperalgesia in rats without inflammatory pain. Nevertheless, the lack of effect of sevoflurane concentrations of 1.0% and 1.5% to oppose hyperalgesia following high-dose fentanyl and inflammatory pain suggests that sevoflurane anti-hyperalgesic properties are weak. RésuméObjectif Les opioı¨des sont largement utilise´s en anesthe´sie mais induisent paradoxalement une hypersensibiliteṕ ostope´ratoire a`la douleur via une modulation des re´cepteurs N-me´thyl-D-aspartate (NMDA). Les effets du

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The Effect of Fentanyl on Sevoflurane Requirements for Somatic and Sympathetic Responses to Surgical Incision

Abstract: MAC and MAC-BAR decreased similarly with increasing concentrations of fentanyl in plasma, showing an initial steep reduction followed by a ceiling effect. In the presence of N2O, MAC and MAC-BAR decreased similarly but did not exhibit a ceiling effect.

Cited by 145 publications

References 23 publications

Remifentanil decreases sevoflurane requirements in children

Remifentanil decreases sevoflurane requirements in children

Minimum Alveolar Concentration for Blunting Adrenergic Responses (MAC-BAR) of Sevoflurane in Dogs

Effects of sevoflurane on carrageenan- and fentanyl-induced pain hypersensitivity in Sprague-Dawley rats

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