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MINERVA ANESTESIOLOGICA

Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2017 Sep 11

DOI: 10.23736/S0375-9393.17.12065-1

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

The analgesic potency dose of remifentanil to minimise stress response induced by intubation and measurement uncertainty of surgical pleth index

Ji H. PARK 1, Dong-Hee KIM 2, Sun-Kook YOO 3, Hyun-Jun LIM 4, Joo-Won LEE 5, Won-Sik AHN 6, Eun-Kyung LEE 7, Byung-Moon CHOI 8 , Gyu-Jeong NOH 9

1 Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea; 2 University of Ulsan College of Medicine, Seoul, Korea; 3 Department of Medical Engineering, Yonsei University College of Medicine, Seoul, Korea; 4 Graduate School of Biomedical Engineering, Yonsei University, Seoul, Korea; 5 Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; 6 Blood Flow Data Center, Kyunghee University Medical Center, Seoul, Korea; 7 Department of Statistics, Ewha Womans University, Seoul, Korea; 8 Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; 9 Department of Clinical Pharmacology and Therapeutics, Asan Medical Center, University of Ulsan, Seoul, Korea


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BACKGROUND: The aim of this study was to evaluate the analgesic potency dose of remifentanil to maintain surgical pleth index (SPI) values at less than 50 after intubation in patients undergoing general anaesthesia with target-controlled infusion of propofol and remifentanil.
METHODS: We randomly allocated 120 patients to receive one of three remifentanil target effect-site concentrations (5, 7, or 9 ng⋅ml-1) during intubation. The target effect-site concentrations of propofol were adjusted within a range of 2.5−3 μg⋅ml-1 to maintain bispectral index values at less than 60 during anaesthesia induction. A reusable SPI sensor was placed on the index finger of the arm, and the SPI values were continuously recorded. The predicted probability for maintaining the SPI values at less than 50 after intubation against the cumulative amount of remifentanil was analysed using logistic regression. The measurands were the baseline SPI value in patients without pain scheduled for surgery, and the maximal SPI value after intubation in patients receiving remifentanil with a target effect- site concentration of 7 ng⋅ml-1.
RESULTS: The estimated cumulative amount of remifentanil associated with a 50% and 95% probability of maintaining the SPI values at less than 50 after intubation were 135.0 μg and 330.4 μg, respectively. The estimated expanded uncertainty for the baseline and maximal SPI values after intubation in patients scheduled for surgery were 54.9±44.4 and 54.1±37.9, respectively, which corresponded to a confidence level of approximately 95%.
CONCLUSIONS: The analgesic potency dose of remifentanil to maintain SPI values at less than 50 after intubation was 135.0 μg.


KEY WORDS: Intubation - Measurement - Potency - Surgical stress

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Publication History

Article first published online: September 11, 2017
Manuscript accepted: September 1, 2017
Manuscript revised: July 21, 2017
Manuscript received: March 13, 2017

Per citare questo articolo

Park JH, Kim DH, Yoo SK, Lim HJ, Lee JW, Ahn WS, et al. The analgesic potency dose of remifentanil to minimise stress response induced by intubation and measurement uncertainty of surgical pleth index. Minerva Anestesiol 2017 Sep 11. DOI: 10.23736/S0375-9393.17.12065-1

Corresponding author e-mail

byungmoonchoi7@gmail.com