Propofol 마취에서 기관내 삽관 시 Remifentanil의 효과처 농도에 따른 혈역학과 Bispectral Index의 변화 = Changes of Hemodynamics and Bispectral Index by Tracheal Intubation according to Effect-Site Concentration of Remifentanil during Propofol Anesthesia

다국어 초록 (Multilingual Abstract)

Combination of propofol and remifentanil is an ideal regimen for total intravenous anesthesia, and the bispectral index (BIS) has been used as an indicator of the sedative state during anesthesia. This study examined the effect of remifentanil on the mean arterial pressure (MAP), heart rate (HR) and BIS to laryngoscopy and tracheal intubation with 4μg/ml of fixed target effect-site concentration infusion of propofol.
Methods: In this double-blind study, fifty-one ASA physical status I-II patients, aged 20−60 yr undergoing elective surgery were randomly assigned to one of four groups according to the target effect-site concentration of remifentanil (0, 2, 3, 4 ng/ml). The target-controlled infusion (TCI) of remifentanil was initiated after the effect-site concentration of propofol was maintained with 4μg/ml. After target effect-site concentration of remifentanil was reached, a neuromuscular blockade was produced by rocuronium 1 mg/kg and tracheal intubation was performed after 90 seconds. MAP, HR and BIS were measured at pre-induction, after reaching target effect-site concentration of propofol and remifentanil, before and after tracheal intubation.
Results: The changes of MAP, HR and BIS after tracheal intubation were negatively correlated with remifentanil effect-site concentration.
Conclusions: Remifentanil attenuated the hemodynamic responses due to tracheal intubation and decreased BIS after tracheal intubation in a comparable dose-dependent fashion.

참고문헌 (Reference)

1 "The pharmacodynamics of propofol in female patients" 77 : 3-9, 1992

2 "The interaction of fentanyl on the Cp50 of propofol for loss of consciousness and skin incision" 81 : 820-8, 1994

3 "The effect-site concentration of remifentanil blunting cardiovascular responses to tracheal intubation and skin incision during bispectral index-guided propofol anesthesia" 101 : 125-130, 2005

4 "The effect of remifentanil on the bispectral index change and hemodynamic responses after orotracheal intubation" 90 : 161-167, 2000

5 "The bispectral index and modified observer's assessment of alertness/sedation scale comparable to effect site concentration of propofol in Koreans" 38 : 251-257, 2000

6 "Remifentanil: a novel, short-acting, mu-opioid" 83 : 646-651, 1996

7 "Reduction by fentanyl of the Cp50 values of propofol and hemodynamic responses to various noxious stimuli" 87 : 213-227, 1997

8 "Pharmacodynamic interaction between propofol and remifentanil regarding hypnosis, tolerance of laryngoscopy, bispectral index, and electroencephalographic approximate entropy" 100 : 1353-1372, 2004

9 "Hemodynamic responses according to different effect site concentration of remifentanil during endotracheal intubation" 9 : 191-196, 2005

10 "Hemodynamic response to induction and intubation.Propofol/ fentanyl interaction" 81 : 1384-93, 1994

11 "Evaluation of remifentanil for control of haemodynamic response to tracheal intubation" 53 : 1223-1227, 1998

12 "Electroencephalographic bispectral index correlates with intraoperative recall and depth of propofol-induced sedation" 84 : 185-189, 1997

13 "Effect of remifentanil on the haemodynamic response to orotracheal intubation" 80 : 467-469, 1998

14 "Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation" 59 : 295-9, 1987

15 "Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers" 86 : 836-847, 1997

16 "An experience of BIS monitoring for the measurement of hypnotic state during general anesthesia using a profol TCI" 36 : 729-735, 1999

17 "A review of the pharmacokinetics and pharmacodynamics of remifentanil" 89 : S7-S14, 1999

18 "A primer for EEG signal processing in anesthesia" 89 : 980-1002, 1998