The effects of remifentanil on haemodynamic stability during rigid bronchoscopy

Abstract

We examined the effect of remifentanil on the haemodynamic response to rigid bronchoscopy in 22 adult ASA 2–4 patients, randomly allocated to receive 1.0 µg.kg−1 remifentanil over 1 min followed by 0.5 µg.kg−1.min−1 (remifentanil group) or 2.0 µg.kg−1 fentanyl followed by a saline infusion (control group). Following the initial infusion, all patients received a sleep dose of propofol followed by rocuronium 0.6 mg.kg−1 and their lungs were ventilated using a Sander's injector attached to the rigid bronchoscope. Direct arterial blood pressures, heart rate and ST segment changes on the CM5 lead configuration of the electrocardiograph were measured at 1‐min intervals from before induction of anaesthesia until the end of bronchoscopy. Arterial pressures and heart rate were similar in the two groups before and after induction of anaesthesia. Remifentanil attenuated the haemodynamic response to bronchoscopy (p < 0.05 for increases in arterial pressures and heart rate). Four patients in the remifentanil group had ST segment depression compared with eight patients in the control group, but this was not statistically significant.

Anaesthesia and peri-interventional morbidity of rigid bronchoscopy: A retrospective analysis

“…The resulting hypertension, tachycardia and dysrhythmias increase the peri-operative risk for subgroup of patients with coronary artery disease, existing hypertension, preeclampsia and intracranial pathologies such as aneurysms [4]. Pharmacological agents such as intravenous or topical lignocaine, opioids such as remifentanil, nifidipine, clonidine, gabapentin, esmolol and magnesium sulphate had been described with variable success in ameliorating the haemodynamic response to tracheal intubation [5][6][7][8][9][10][11]. In a recent Cochrane review, the risk of dysrhythmias was reduced with administration of local anaesthetics, calcium channel blockers, beta blockers and narcotics as compared to placebo and showed reduced ECG evidence of myocardial ischaemia [12].…”

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“…Adjunct remifentanil use during RB with propofol or inhalational anesthetics along with either spontaneous or controlled ventilation has been described previously (15)(16)(17)(18)(19)(20)(21). The infusion rates of remifentanil were 0.5 mg/kg/min or lower in those studies.…”

“…Intermittent propofol injections instead of continuous infusion during rigid bronchoscopy may be preferred as a practical technique in some centers (17,28), as in our institution. In this study, to decrease the recovery time and risk of awareness, propofol or ketamine infusions instead of bolus doses and bispectral index monitoring may be more appropriate.…”

Anesthesia for interventional pulmonology procedures: a review of advanced diagnostic and therapeutic bronchoscopy

“…106 Remifentanil bolus (1 g·kg −1 ) followed by infusion (0.3 g·kg −1 ·min −1 ) can effectively attenuate the cardiovascular response to bronchoscopy better than fentanyl (2 g·kg −1 ). 107 Similarly, a remifentanil bolus of 2 g·kg −1 (in addition to a target-controlled infusion of propofol) attenuates the cardiovascular response during rigid bronchoscopy better than remifentanil at 1 g·kg −1 . 108 Recent literature supports the use of higher doses of remifentanil infusions (0.25-0.5 g·kg −1 ·min −1 ) over lower doses, as these are associated with lower risk of coughing and laryngospasm and increased proceduralist satisfaction.…”