Advances in Clinical and Experimental Medicine

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Advances in Clinical and Experimental Medicine

2013, vol. 22, nr 1, January-February, p. 47–55

Publication type: original article

Language: English

Different Remifentanil Doses in Rapid Sequence Anesthesia Induction: BIS Monitoring and Intubation Conditions

Różne dawki remifentanylu w szybkiej indukcji znieczulenia – monitorowanie BIS i warunki intubacji

Zekeriyya Alanoğlu1,A,B,C,D,E,F, Sinem Tolu2,C,D,E,F, Şaban Yalçın3,A,B,C,D,E,F, Yeşim Batislam4,C,E,F, Oya Özatamer4,C,E,F, Filiz Tüzüner4,C,F

1 Ankara University School of Medicine, Department of Anaesthesiology & ICM, Ankara, Turkey

2 Ankara University Medical Faculty Department of Anaesthesiology & Reanimation, Ankara, Turkey

3 Harran University School of Medicine, Department of Anaesthesiology & ICM, Şanlıurfa, Harran, Turkey

Abstract

Objectives. The aim of this prospective, randomized, double blind trial was to investigate the effects of two different doses of remifentanil on bispectral index (BIS) values and intubation conditions in a simulated model of rapid sequence anesthesia induction (RSAI).
Material and Methods. 54 ASA I-II adult patients undergoing elective surgery were randomly allocated to two groups. After preoxygenation for 3 minutes, induction and tracheal intubation was performed in a 30o head-up position. Group I (n = 26) and Group II (n = 28) received a 1 µg/kg or 0.5 µg/kg bolus of remifentanil, respectively, over 30 seconds. Propofol was the induction agent. 1 mg/kg of rocuronium was used in all patients. Patients were intubated 60 s after administration of the muscle relaxant. Hemodynamic data and BIS scores were obtained before induction (baseline), after induction, at intubation and at 1, 3, 5 and 10 minutes following intubation. Intubation conditions were scored with a standard scoring system.
Results. The hemodynamic variables at all the measurement intervals and the area under the hemodynamic variable-time curves were similar among the groups. There was no difference among the groups for BIS measurements. Moreover, the mean area under the BIS-time curve for Group I (300 ± 45 cm2) was comparable to Group II (315 ± 49 cm2) (p = 0.432). The mean total intubation condition score (maximum 14 points) in Group I (12.6 ± 1.67) was higher than Group II (10.3 ± 4.79) (p = 0.030).
Conclusion. 1 µg/kg of remifentanil compared to 0.5 µg/kg of remifentanil provides similar hemodynamic profiles and BIS scores, but 1 µg/kg of remifentanil was associated with superior endotracheal intubation conditions. According to this study design and medications used, a relation between BIS scores and intubation conditions couldn’t be demonstrated.

Streszczenie

Cel pracy. Celem tego prospektywnego, randomizowanego, podwójnie ślepego badania było zbadanie wpływu dwóch różnych dawek remifentanylu na wskaźnik bispektralny (BIS) i warunki intubacji w symulowanym modelu sekwencji szybkiej indukcji znieczulenia (RSAI).
Cel pracy. Materiał i metody.
Materiał i metody. 54 dorosłych pacjentów I–II ASA poddawanych planowej operacji przydzielono losowo do dwóch grup. Po 3 minutach wstępnego natleniania pacjentów, przeprowadzono indukcję i intubację w położeniu głową do góry pod kątem 30o. Grupa I (n = 26) oraz grupa II (n = 28) otrzymały 1 mg/kg lub 0,5 mg/kg w bolusie remifentanylu, odpowiednio, w ciągu 30 sekund. Propofol był środkiem indukcyjnym. Wykorzystano 1 mg/kg rokuronium u wszystkich pacjentów. Pacjentów intubowano 60 s po podaniu środka zwiotczającego mięśnie. Dane hemodynamiczne i wyniki BIS uzyskano przed indukcją (stan początkowy), po indukcji, podczas intubacji i 1, 3, 5 i 10 minut po intubacji. Warunki intubacji oceniono za pomocą standardowego systemu punktacji.
Wyniki. Hemodynamiczne zmienne we wszystkich przedziałach pomiarowych i obszar pod krzywymi hemodynamicznymi w zależności od czasu były podobne w obu grupach. Nie było różnicy między grupami dla pomiarów BIS. Ponadto średnia powierzchnia pod krzywą BIS w zależności od czasu w grupie I (300 ± 45 m2) była porównywalna do grupy II (315 ± 49 m2) (p = 0,432). Średnia całkowita ocena intubacji (maksymalnie 14 punktów) w grupie I (12,6 ± 1,67) była większa niż w grupie II (10,3 ± 4,79) (p = 0,030).
Wnioski. Dawka 1 mg/kg w porównaniu z 0,5 mg/kg remifentanilu zapewnia podobne profile hemodynamiczne i wyniki BIS, ale 1 mg/kg remifentanilu był związany z lepszymi wewnątrztchawicznymi warunkami intubacji. Według tego projektu badania i stosowanych leków, nie wykazano związku między wynikami BIS a warunkami intubacji.

Key words

anesthesia induction, endotracheal intubation, rapid-sequence anesthesia induction, bispectral index, remifentanil.

Słowa kluczowe

indukcja znieczulenia, intubacja dotchawicza, sekwencja szybkiej indukcji znieczulenia, wskaźnik bispektralny, remifentanyl.

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