Smartest Doc
Effect of a target-controlled infusion of remifentanil in combination with desflurane during the maintenance phase of general anesthesia Full Text
Korean Journal of Anesthesiology, 07/31/2012
Clinical Article
Shin MK et al. – The authors recommend the use of 2ng/ml or less remifentanil combined with desflurane for decreasing concentrations of desflurane without significant side effects, during the "maintenance" phase, and not during the induction phase of general anesthesia.
Methods- Ninety ASA I patients, who underwent general anesthesia for elective orthopedic or extremity surgeries, were registered and randomly allocated to receive either a target–controlled concentration of 1ng/ml (group R1), 2ng/ml (group R2) remifentanil, or desflurane only without remifentanil infusion (group D).
- Mean arterial pressure (MAP) and heart rate (HR) were recorded at 5–min intervals from after a 10–15min period of surgical incision to before a 10–min period prior to the end of an operation.
- End–tidal concentration of desflurane was increased or decreased in proportion to the changes in MAP and HR.
- If the value of bispectral index (BIS) was from 60–62 for more than 2min or systolic blood pressure would fall below 90mmHg, the patient was excluded from the study to prevent a risk of "explicit awareness" and shock.
- The end–tidal desflurane concentration was lower in the group receiving 1ng/ml (5.2±0.5 vol%; P<0.001) and 2ng/ml remifenanil (4.4±0.5 vol%; P<0.001) compared to patients in group D (7.9±0.5 vol%).