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ANESTHETIC PHARMACOLOGY

The Effect-Site Concentration of Remifentanil Blunting Cardiovascular Responses to Tracheal Intubation and Skin Incision During Bispectral Index-Guided Propofol Anesthesia

Department of Anesthesiology-IRCCS H. San Raffaele, Vita-Salute University of Milano, Milan, Italy

Address correspondence and reprint requests to Andrea Albertin, MD, Department of Anesthesiology, IRCCS H San Raffaele, Via Olgettina 60, 20132 Milan. Address e-mail to albertin.andrea{at}hsr.it.

We sought to determine the effect-site concentration of remifentanil blunting sympathetic responses to tracheal intubation and skin incision during bispectral index (BIS)-guided propofol anesthesia. Forty-one ASA physical status I–II patients, aged 20–65 yr and undergoing major abdominal surgery, were randomly assigned to one of two groups: tracheal intubation (group TI, n = 20) or skin incision (group SI, n = 21). All patients received a target-controlled infusion of propofol of 4 µg/mL, which was then adjusted to maintain a BIS value ranging between 40 and 50. The effect-site concentration of remifentanil blocking the sympathetic responses to tracheal intubation and skin incision in 50% of cases (Ce50) was determined using an up-and-down sequential allocation method. The mean (95% confidence interval [CI]) Ce50 of remifentanil was 5.0 ng/mL for TI (95% CI, 4.7–5.4 ng/mL) and 2.1 ng/mL for SI (95% CI, 1.4–2.8 ng/mL). This study shows that effect-site concentrations of remifentanil of 5 ng/mL and 2 ng/mL are effective in blunting sympathetic responses to tracheal intubation and skin incision in 50% of patients when combined with a BIS-guided target controlled infusion of propofol.

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