The Effects of Fentanyl on Sevoflurane Requirements for Loss of Consciousness and Skin Incision

Katoh, Takasumi; Ikeda, Kazuyuki

doi:10.1097/00000542-199801000-00006

Cited by 146 publications

(60 citation statements)

References 19 publications

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“…1,6 Because opioids decrease sevoflurane minimum alveolar concentration (MAC) and heart rate, they may reduce hemodynamic changes and time to tracheal intubation. [7][8][9][10] However asystole or severe hypotension may occur, probably because of inappropriate opioid dosing, and the effects of sevoflurane-alfentanil on the ease and speed of tracheal intubation have not been evaluated. 9,[11][12][13] Our study aimed to determine the dose of alfentanil required to decrease the time to tracheal intubation and blunt the increase in heart rate associated with an inhalation induction.…”

Section: Me Et Th Ho Od Ds S:mentioning

confidence: 99%

Low alfentanil target-concentrations improve hemodynamic and intubating conditions during induction with sevoflurane

Nathan

Vandroux

Benrhaiem

et al. 2004

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To investigate the effects of different alfentanil target-concentrations on hemodynamics, respiration and conditions of tracheal intubation during an inhalation induction with 8% sevoflurane. M Me et th ho od ds s: :In this prospective randomized open-label study, 40 ASA I adult patients received alfentanil at the following target-concentrations: zero (Group 0), 25 (Group 25), 50 (Group 50) and 75 ng·mL -1 (Group 75), starting five minutes before induction of anesthesia with 8% sevoflurane in 50% nitrous oxide. The ease of intubation was determined on fixed criteria and scored; arterial pressure, heart rate and bispectral index (BIS) were recorded at one-minute intervals.R Re es su ul lt ts s: : Times to allow tracheal intubation were shortened only in Group 75 (94 ± 8 sec) as compared to Group 0 (140 ± 11 sec, P < 0.05). BIS values, tracheal intubation scores and number of attempts were not different between groups. However, more patients suffered from apnea in Group 75. Heart rate and mean arterial pressure remained stable in Group 75 whereas they increased significantly in the three other groups. No patient suffered hypotension.C Co on nc cl lu us si io on n: : Adding alfentanil at a 75 ng·mL -1 target-concentration during an inhalation induction with 8% sevoflurane in 50% nitrous oxide allows intubation slightly earlier and provides stable hemodynamic conditions but the incidence of apnea during induction is higher. Lower concentrations are of little clinical interest. Objectif : Rechercher les effets de différentes concentrations cibles d'alfentanil sur l'hémodynamique, la respiration et les conditions d'intubation endotrachéale pendant l'induction par inhalation de sévoflu-rane à 8 %. Méthode : L'étude prospective, randomisée et ouverte comportait 40 patients adultes d'état physique ASA I recevant de l'alfentanil selon les concentrations cibles suivantes : zéro (Groupe 0), 25 (Groupe 25), 50 (Groupe 50) et 75 ng·mL -1 (Groupe 75), cinq minutes avant l'induction de l'anesthésie avec du sévoflurane à 8 % dans 50 % de protoxyde d'azote. La facilité d'intubation a été évaluée d'après des critères fixes, et cotée ; la tension artérielle, la fréquence cardiaque et l'index bispectral (BIS) ont été notés à intervalles d'une minute. Résultats : L'intervalle précédant l'intubation endotrachéale a été plus court dans le

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Section: Me Et Th Ho Od Ds S:mentioning

confidence: 99%

Low alfentanil target-concentrations improve hemodynamic and intubating conditions during induction with sevoflurane

Nathan

Vandroux

Benrhaiem

et al. 2004

Can J Anesth/J Can Anesth

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“…Although the absence of a purposeful motor response has been traditionally used to determine anaesthetic potency [41] ,there is evidence to suggest that loss of consciousness and response to noxious stimuli are not consistent with a scale of increasing 'depth' of anesthesia but rather are two separate phenomena [42].…”

Section: Discussionmentioning

confidence: 99%

Comparison of the qCON and qNOX indices for the assessment of unconsciousness level and noxious stimulation response during surgery

Melia¹,

Gabarron²,

Agustí

et al. 2016

J Clin Monit Comput

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Purpose. The objective of this work is to compare the behavior of two electroencephalogram (EEG) based indices after drug induction and during recovery of consciousness.Methods. Data was recorded from 140 patients scheduled for general anaesthesia with a combination of propofol and remifentanil. The qCON 2000 monitor (Quantium Medical, Barcelona, Spain) was used to calculate the qCON and qNOX. The fall times and the rise times were defined at the start and at the end of the surgery. Loss of response to verbal command and loss of eye-lash reflex were assessed during the transition from awake to anesthetized, defining the state of loss of consciousness (LOC). Movement as a response to laryngeal mask (LMA) insertion was interpreted as the response to the nociceptive stimuli. The patients were classified as movers or non-movers. The values of qCON and qNOX were statistically compared. Conclusion.The indices qCON and qNOX were able to detect differences between the times of actions of hypnotic and analgesic agents. The qCON showed faster decrease during induction while the qNOX showed a faster increase during recovery.

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“…49 (Glass et al 1999) 1.17 (Glass et al 1999) Ce (50% ➘ MAC) 1.7 (Katoh and Ikeda 1998;Westmoreland et al 1994) 29 (Westmoreland et al 1994) 0.14 (Brunner et al 1994) 1.37 (Lang et al 1996) 1 after injection, and completely recovered within 15 min after injection (Babenco et al 2000). This allowed the estimation of k e0 (0.24 min −1 ) and EC50 (1.12 ng/ml) for respiratory effect.…”

Section: Respiratory Effectsmentioning

confidence: 97%

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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The Effects of Fentanyl on Sevoflurane Requirements for Loss of Consciousness and Skin Incision

Abstract: The reduction in sevoflurane requirements for loss of consciousness and skin incision by fentanyl was determined. Fentanyl reduced both requirements, but the mode of the reduction was not comparable.

Cited by 146 publications

References 19 publications

Low alfentanil target-concentrations improve hemodynamic and intubating conditions during induction with sevoflurane

Low alfentanil target-concentrations improve hemodynamic and intubating conditions during induction with sevoflurane

Comparison of the qCON and qNOX indices for the assessment of unconsciousness level and noxious stimulation response during surgery

Remifentanil and Other Opioids

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