임상연구 : 근이완제 투여 없이 Remifentanil을 사용한 기관 삽관 시 마취 유도제로 사용된 Thiopental, Propofol, Etomidate가 기관 삽관 환경 및 혈역학적 변화에 미치는 영향

김용호 ( Yong Ho Kim ),민진혜 ( Jin Hye Min ),최영순 ( Young Soon Choi ),이우경 ( Woo Kyung Lee ),이용경 ( Yong Kyung Lee ),이현민 ( Hyun Min Lee ),채영근 ( Young Keun Chae ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.1

Background: Many studies have suggested that propofol in combination with remifentanil may provide adequate conditions for tracheal intubation without the use of muscle relaxants. Other hypnotic drugs have not been thoroughly investigated in this regard. The goal of our study was to evaluate the effect of thiopental, propofol or etomidate on tracheal intubating conditions and hemodynamic changes using remifentanil in the absence of muscle relaxants. Methods: A total of 45 healthy adults were divided randomly into three groups. After iv lidocaine 1.5 mg/kg, thiopental 5 mg/kg (thiopental group) or propofol 2.5 mg/kg (propofol group), or etomidate 0.4 mg/kg (etomidate group) were injected. After the injection of study drugs, remifentanil 2 mcg/kg was administered. Ninety seconds after the administration of remifentanil, laryngoscopy and intubation were attempted. Intubating conditions were assessed and the mean arterial pressure and the heart rate was measured. Results: There were no significant differences in intubating conditions between patients in the three groups. The heart rate was significantly lower in the propofol and etomidate group patients when compared to the thiopental group patients after anesthetic induction. The mean arterial pressure was significantly lower in the propofol group patients when compared to the thiopental and etomidate group patients. Both heart rate and mean arterial pressure after tracheal intubation were significantly elevated in etomidate group patinets when compared to their preintubation value. Conclusions: The use of thiopental 5 mg/kg, propofol 2.5 mg/kg, and etomidate 0.4 mg/kg did not differ in effect under intubating conditions for tracheal intubation using remifentanil in the absence of muscle relaxants. Thiopental provided the best hemodynamic conditions. (Korean J Anesthesiol 2007; 53: 61~6)

임상연구 : 통원수술 환자에서 Propofol과 Remifentanil 목표농도조절주입과 소량의 Rocuronium을 병용한 마취유도 시 기관내삽관의 조건과 혈역학 변화

김종엽 ( Jong Yeop Kim ),김재형 ( Jae Hyung Kim ),박성용 ( Sung Yong Park ),이현호 ( Hyun Ho Lee ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.5

Background: This study evaluated the tracheal intubating conditions and hemodynamic changes in tracheal intubation according to the different effect-site concentrations of remifentanil combined with a target controlled infusion (TCI) of propofol using low dose rocuronium. Methods: Forty-five patients presenting for ambulatory surgery were randomly assigned to one of three groups according to the target effect-site concentration of remifentanil: 2.5 ng/ml (group R2.5), 3.0 ng/ml (group R3.0), 3.5 ng/ml (group R3.5). After midazolam administration, anesthesia was induced using a target effect-site controlled infusion of propofol 4.0μg/ml, which was then reduced to 2.5μg/ml. At the same time, a TCI of remifentanil was started. A neuromuscular blockade was produced by rocuronium 0.4 mg/kg. The trachea was intubated 4 min after induction. The tracheal intubation conditions were assessed using a standard scoring system. The noninvasive arterial blood pressure, heart rate (HR), and bispectral index were recorded at 1 min intervals from the start of induction to 5 min after intubation. Results: Intubation was successful in all patients except for one in the R2.5 group. The number of excellent intubating conditions was significantly higher in the R3.5 group (12/15) than in the R2.5 group (6/15) (P < 0.05). The mean arterial pressure (MAP) in the R2.5 and R3.0 groups increased significantly at 1 min after intubation (P < 0.05), but the MAP in the R3.5 group increased slightly at 1 min after intubation. Conclusions: The effect-site concentration of remifentanil 3.5 ng/ml combined with a TCI of propofol using rocuronium 0.4 mg/kg provides the most adequate intubating conditions and hemodynamic stability. (Korean J Anesthesiol 2006; 51: 535~40)

Effects on Intubating Conditions of Pretreatment with Remifentanil before Administration of Cisatracurium

Hye Jin Jeong,Seong Heon Lee,Hwi Jin Kim,곽상현 전남대학교 의과학연구소 2012 전남의대학술지 Vol.48 No.2

Cisatracurium provides superior hemodynamic stability with only minor release of histamine,and its metabolism via Hoffman elimination is independent of organ function. However, use of cisatracurium is limited because of reportedly slower onset and unsatisfactory intubating conditions. Many studies have shown that remifentanil might provide reliable intubating conditions; thus, we hypothesized that pretreatment with remifentanil before administration of cisatracurium might result in acceptable intubating conditions. Sixty healthy patients scheduled for elective surgery were enrolled and randomly divided into three groups: saline (Group I, n=20), remifentanil 0.5 μg/kg (Group II, n=20), and remifentanil 1.0 μg/kg (Group III, n=20). The anesthesia was induced with propofol 2.0 μg/kg given intravenously over 30 s followed by injection over 30 s of a different dose of remifentanil according to the study protocol. We examined the intubating condition by jaw relaxation, vocal cord state, and diaphragmatic response 90 s after administering cisatracurium. We also measured mean blood pressure,heart rate, and the onset time, which is the interval from the end of neuromuscular blocking agent administration until suppression of maximal T1 on a train-of-four sequence. The mean values of the intubating condition after endotracheal intubation in Groups II and III were significantly lower than that in Group I (p<0.005), although the overall onset time of cisatracurium did not differ significantly between the three groups. Our results suggest that supplementation with remifentanil in an induction regimen with cisatracurium improves the quality of the intubating condition even though the onset time of cisatracurium is not shortened.

저용량의 Rocuronium을 사용한 기관내 삽관 시 사전예비정주법이 Rocuronium의 작용 발현시간과 삽관 조건에 미치는 영향

손윤숙 ( Yoon Suk Son ),정규돈 ( Kyu Don Chung ),조현숙 ( Hyun Sook Cho ),유승준 ( Sung Jun Yu ),김수화 ( Su Hwa Kim ),이상묵 ( Sang Mook Lee ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.4

Background: A priming dose of rocuronium can shorten the onset time of neuromuscular blockade. The purpose of this study was to evaluate the effect of priming with rocuronium on the onset time and intubation conditions during tracheal intubation with low-dose rocuronium (0.35 mg/kg) and to compare results with those for rocuronium 0.45 mg/kg. Methods: One hundred twenty four patients were randomly allocated to three groups. Following induction of anesthesia, groups I and III received normal saline while group II received a priming dose of rocuronium (0.05 mg/kg). Three minutes after priming, groups I, II and III received, respectively, 0.45 mg/kg, 0.3 mg/kg and 0.35 mg/kg rocuronium. Intubation was performed 2 minutes after the administration of an intubating dose and intubation conditions were evaluated. Neuromuscular blockade was assessed by accelerography. Results: The proportion of cases having optimal intubation conditions in group I was higher than in groups II and III. There was no significant difference in the onset times among groups. Neuromuscular blockade at 60, 90 and 120 seconds after an intubating dose was similar among all groups except at 60 sec. Maximal blockade for group I was deep compared to groups II and III. Conclusions: Rocuronium 0.35 mg/kg does not provide satisfactory intubation conditions. There are no effects on onset time and intubation conditions due to priming during tracheal intubation with rocuronium 0.35 mg/kg. (Korean J Anesthesiol 2009;57:444∼9)

Sevoflurane과 Remifentanil로 마취유도 시 저용량 Rocuronium이 기관내 삽관조건에 미치는 영향

손윤숙 대한마취통증의학회 2007 Anesthesia and pain medicine Vol.2 No.4

Background: We evaluated the effect of low doses of rocuronium on tracheal intubating conditions and hemodynamic changes during induction of anesthesia with 8 vol% sevoflurane and remifentanil 1μg/kg. Methods: Eighty four patients were randomized into one of three groups; Group I, II, III. Each group received normal saline, 0.3, 0.45 mg/kg of rocuronium respectively. Predetermined drugs for each group and remifentanil 1μg/kg were administered during induction of 8 vol% sevoflurane. After induction of 8 vol% sevoflurane, tracheal intubation was preformed. The tracheal intubation conditions and hemodynamic responses to tracheal intubation were assessed. Results: Tracheal intubation was successful in all patients. The incidence of clinically acceptable intubating conditions was 79% in Group I, 100% in Group II, and 100% in Group III. There was no significant difference in intubating condition between Group II and Group III. The hemodynamic responses to tracheal intubation were blunted in all groups. Conclusions: After induction with 8 vol% sevoflurane and remifentanil 1μg/kg, low-dose rocuronium provides more satisfactory tracheal intubation conditions.

실제 체중과 이상적 체중에 근거한 Remifentanil 투여 용량이 기관 내 삽관 상태와 혈역학적 부작용에 미치는 영향

김신성 대한마취통증의학회 2007 Anesthesia and pain medicine Vol.2 No.1

Background: Remifentanil presents good intubation conditions and blunting adverse hemodynamic responses following intubation. So, we evaluated to determine optimal dosage of remifentanil for intubation which consider ideal body weight. Methods: 160 ASA class 1-2 patients were selected and divided 4 groups, which were composed of 40 patients. Group 1 and 2 were administrated dosage calculated by TBW (total body weight). Each group was administrated intravenous continuous infusion dose of 1.0 ug/kg/min of remifentanil during 2 minutes followed by intravenous bolus dose of 2 mg/kg of propofol (Group 1) and 2.0 ug/kg/min of remifentanil followed by same dose of propofol (Group 2). Group 3 and 4 were administerated same dosage of Group 1 and 2 but administrated dosage calculated by IBW (ideal body weight). We didn’t use any muscle relaxant. Intubation conditions and postintubation hemodynamic responses were assessed by 5 items based on GCRP (good clinical research practice), MAP (mean arterial pressure) and HR (heart rate). Results: We have done intubation safely 60, 75, 55 and 98% of Group 1, 2, 3 and 4 respectively. Group 1, 3 have ‘technically unacceptable’ cases, but group 2, 4 have ‘clinically unacceptable’ cases. Hemodynamic responses of Group 4 were more stable than Group 2, especially obese patients. Obese patients present a problem for the appropriate dosing of remifentanil and profound hypotension and/or bradycardia developed more frequently when administerated agent calculated by total body weight. Conclusions: The optimal dosage which produce best intubation conditions and least side effects has to be determined according to IBW.

Clinical Research Comparison of intubating conditions and hemodynamic responses to tracheal intubation with different effect-site concentrations of remifentanil without muscle relaxants during target-controlled infusion of propofol

Seok Jai Kim,Kyung Yeon Yoo,Byoung Yun Park,Woong Mo Kim,Cheol Won Jeong 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.1

Background: We compared the effects of different remifentanil effect-site concentrations on intubating conditions, and cardiovascular and bispectral index score (BIS) responses to intubation at a fixed effect-site concentration of propofol without muscle relaxants. Methods: Sixty-four patients were randomly assigned to one of three groups: remifentanil 2 (group R2, n=22), 4 (group R4, n=21), or 6 ng/ml (group R6, n=21). Anesthesia was induced using target-controlled infusion of propofol 5 μg/ml and each concentration of remifentanil. Laryngoscopy and intubation was attempted at 2.5 min following induction. Intubating conditions were assessed as excellent, good or poor using a standard scoring system. Mean arterial pressure (MAP), heart rate (HR), and BIS values were assessed. Results: Excellent or good intubating conditions were obtained in 91% of group R4 and 95% of R6, both of which are higher compared with 32% of R2 (P<0.01). MAP and HR decreased significantly after induction in all groups. After intubation, they recovered to baseline value in group R2 and R4 but were significantly less than baseline values in R6. BIS response to intubation was attenuated in group R4 and R6 but not R2. Hypotension was more frequent in group R6 than R2. Conclusions: Remifentanil target concentrations of 4 or 6 ng/ml combined with 5 μg/ml propofol provided good or excellent conditions for tracheal intubation and prevented cardiovascular and BIS response during induction without muscle relaxants. However, the use of 6 ng/ml dose was associated with frequent occurrence of hypotension and bradycardia requiring treatment. (Korean J Anesthesiol 2009; 57 13~9)

임상연구 : 근이완제 투여 없이 Propofol과 Remifentanil만을 사용한 기관내삽관

정봉찬 ( Bong Chan Jung ),이정은 ( Jung Un Lee ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.6

Background: Using alfentanil followed by an anesthetic induction dose of propofol provides adequate conditions for tracheal intubation without neuromuscular blocking drugs in most patients. Providing an option for intense opioid effect without compromising recovery after short operations, remifentanil might offer benefits over alfentanil. In this study intubating conditions after remifentanil-propofol were evaluated. Methods: Sixty healthy premedicated patients were divided randomly into 3 groups. Anesthesia was intravenously induced with propofol (4μg/ml) followed by remifentanil. Group R2, R3, R4 received 2, 3, 4μg/kg remifentanil, respectively. Ninety seconds after the administration of remifentanil, laryngoscopy and intubation were attempted. Intubation conditions were assessed as excellent, good or poor. The hemodynamic changes were measured at preinduction (base), preintubation, postintubation (immediately, 3 minute, 5 minute after intubation). Results: Clinically acceptable intubating conditions were observed in 65%, 95%, and 95% of patients in the R2, R3, and R4 groups, respectively. Clinically acceptable intubating conditions were significantly (P < 0.05) less likely to occur in Group R2. The mean arterial pressure decreased immediately after induction in all groups. There was no significant elevation in heart rate after tracheal intubation in all groups. There were no significant differences among groups. Conclusions: Healthy, premedicated patients with favorable airway anatomy can be reliably intubated with good or excellent conditions 90 seconds after the administrations of remifentanil 3-4μg/kg and propofol. (Korean J Anesthesiol 2006; 50: 623~8)

Is the rapid sequence induction possible with 0.6 mg/kg rocuronium in pediatric patient?

Sang Kyu Lee,Ji Hee Hong,Ae Ra Kim 대한마취과학회 2010 Korean Journal of Anesthesiology Vol.58 No.1

Background: We have investigated the possibility of rocuronium 0.6 mg/kg and timing principle application with the same dose for rapid sequence induction (RSI) in 65 children, aged 4-8 yr. Methods: Sixty five patients were randomly assigned to one of two groups; Group A (n = 31, timing principle application) received rocuronium (0.6 mg/kg) followed by administration of propofol (2.5 mg/kg), and group B (n = 36) received rocuronium (0.6 mg/kg) after administration of propofol. Intubation was assessed at 60 seconds just after administration of last injectants. Intubating conditions (jaw relaxation, vocal cord movement, and response to tracheal intubation) were evaluated as excellent, good, fair and poor. Results: Excellent intubation conditions were obtained in 87% in group A and 61% in group B. However, clinically acceptable intubation conditions which means excellent and good did not show any significant difference as 100% (group A) and 99% (group B). Conclusions: In cases of pediatiric patients undergoing elective surgery, RSI was possible irrespective of the use of timing principle. (Korean J Anesthesiol 2010; 58: 20~24)

한국인에서 Succinylcholine 0.6 mg/kg이 기관내삽관에 적절한가?

안태훈 ( Tae Hun An ),이상진 ( Sang Jin Lee ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.2