The optimal dose of remifentanil for acceptable intubating conditions during propofol induction without neuromuscular blockade

Demirkaya, Mustafa; Kelsaka, Ebru; Sarıhasan, Binnur; Bek, Yüksel; Üstün, E.

doi:10.1016/j.jclinane.2011.11.006

Cited by 16 publications

(13 citation statements)

References 29 publications

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“…12 Appropriate doses of remifentanil can suppress the haemodynamic response to tracheal intubation without neuromuscular blocking drugs, yet allow rapid emergence and return of spontaneous ventilation. 13 These characteristics make remifentanil a practical opioid choice in day care anaesthesia. 5 The analgesic effects of remifentanil account for its positive effects on tracheal intubation conditions.…”

Section: Discussionmentioning

confidence: 99%

Tracheal intubation in intellectually disabled patients: Clinical usefulness of remifentanil and sevoflurane without a muscle relaxant

et al. 2013

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Objective: To compare two remifentanil doses (1 mg/kg and 2 mg/kg) in order to determine the preferred dose in intellectually disabled patients undergoing day care dental surgery under sevoflurane-induced general anaesthesia. Methods: Patients were randomly assigned to receive either 1 mg/kg (group 1) or 2 mg/kg (group 2) remifentanil; both groups received 8% sevoflurane anaesthesia induction. All other conditions were identical in both groups. Heart rate (HR), mean arterial pressure (MAP) and intubation conditions were assessed. Results: A total of 27/30 (90.0%) patients in group 1 and 29/30 patients (96.7%) in group 2 had acceptable intubation conditions. Remifentanil administration resulted in significant reductions in HR compared with baseline levels, in both groups. There were no significant between-group differences in HR at any timepoint. MAP decreased significantly compared with baseline in group 2 only. Conclusion: Successful tracheal intubation in intellectually disabled patients can be accomplished with a combination of 1 mg/kg or 2 mg/kg remifentanil and 8% sevoflurane anaesthesia induction, without the requirement for neuromuscular blocking drugs.

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Section: Discussionmentioning

confidence: 99%

Tracheal intubation in intellectually disabled patients: Clinical usefulness of remifentanil and sevoflurane without a muscle relaxant

et al. 2013

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“…Demirkaya et al [7] reported that the effective dose (ED50) of remifentanil at which acceptable intubating conditions were observed in 50% of patients was 1.4 g/kg during induction of anesthesia with propofol 2 mg/kg without a neuromuscular blocker. The dosage of the low-dose remifentanil in the present study was determined with reference to the previous study of Demirkaya et al [7].…”

Section: Discussionmentioning

confidence: 99%

“…The dosage of the low-dose remifentanil in the present study was determined with reference to the previous study of Demirkaya et al [7].…”

Section: Discussionmentioning

confidence: 99%

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Effect of dexmedetomidine on endotracheal intubating conditions during endotracheal intubation without neuromuscular blocker following propofol/remifentanil

Noh

Kim

et al. 2017

Anesth Pain Med

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background:In the present study, we investigated the effect of dexmedetomidine on the intubating conditions and hemodynamic changes during endotracheal intubation following anesthetic induction performed using propofol and remifentanil without a neuromuscular blocking agent. Methods: We selected 70 adult patients aged 20 to 65 years scheduled to undergo general anesthesia. Induction was performed using 2 mg/kg of propofol and 1.5 g/kg of remifentanil. The patients were divided into two groups, a dexmedetomidine group (Group D) and a control group (Group C). Group D received an infusion of dexmedetomidine 1 g/kg for 10 minutes before induction, and Group C received the same volume of normal saline infused in the same manner. Intubating conditions were evaluated and blood pressure and heart rate were recorded at various time points to assess hemodynamic stability. Results: Intubating conditions were evaluated as excellent for 34 patients and good for 1 patient in Group D, and excellent for 4 patients, good for 20 patients, poor for 4 patients, and bad for 7 patients in Group C (P ＜ 0.001). The heart rate was significantly lower in Group D than in Group C at all measurement times. The mean arterial blood pressure was significantly lower in Group C than in Group D at 10 minutes after dexmedetomidine administration (P = 0.049), after the induction of anesthesia (P ＜ 0.001), immediately after endotracheal intubation (P = 0.008), and 3 minutes after endotracheal intubation (P ＜ 0.001). Conclusions: Dexmedetomidine 1 g/kg improved the intubating conditions and stabilized hemodynamic changes following anesthetic induction performed using propofol 2 mg/kg and remifentanil 1.5 g/kg without a neuromuscular blocking agent.

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“…Most studies with this approach in anesthesiology study 20-40 patients [21][22][23][24][25][26][27][28][29] .…”

Section: Discussionmentioning

confidence: 99%

Sugammadex ED90 dose to reverse the rocuronium neuromuscular blockade in obese patients

Silva

Matsui

Kim

et al. 2017

Rev. Col. Bras. Cir.

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Objective: to determine the ED90 (minimum effective dose in 90% of patients) of sugammadex for the reversal of rocuronium-induced moderate neuromuscular blockade (NMB) in patients with grade III obesity undergoing bariatric surgery. Methods: we conducted a prospective study with the biased coin up-and-down sequential design. We chosen the following doses: 2.0mg/Kg, 2.2mg/Kg, 2.4mg/Kg, 2.6mg/Kg, 2.8mg/Kg. The complete reversal of rocuronium-induced NMB considered a T4/T1 ratio ≥0.9 as measured by TOF. After induction of general anesthesia and calibration of the peripheral nerve stimulator and accelerometer, we injected rocuronium 0.6mg/kg. We administered propofol and remifentanil by continuous infusion, and intermittent boluses of rocuronium throughout the procedure. Results: we evaluated 31 patients, of whom 26 had displayed successful reversal of the NMB with sugammadex, and failure in five. The mean time to complete moderate NMB reversal was 213 seconds (172-300, median 25-75%). The ED90 of sugammadex calculated by regression was 2.39mg/kg, with a 95% confidence interval of 2.27-2.46 mg/kg. Conclusion: the ED90 of sugammadex in patients with grade III obesity or higher was 2.39mg/kg.

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The optimal dose of remifentanil for acceptable intubating conditions during propofol induction without neuromuscular blockade

Cited by 16 publications

References 29 publications

Tracheal intubation in intellectually disabled patients: Clinical usefulness of remifentanil and sevoflurane without a muscle relaxant

Tracheal intubation in intellectually disabled patients: Clinical usefulness of remifentanil and sevoflurane without a muscle relaxant

Effect of dexmedetomidine on endotracheal intubating conditions during endotracheal intubation without neuromuscular blocker following propofol/remifentanil

Sugammadex ED90 dose to reverse the rocuronium neuromuscular blockade in obese patients

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