title: A multicenter evaluation of total intravenous anesthesia with remifentanil and propofol for elective inpatient surgery.
abstract: Remifentanil is a mu-opioid receptor agonist with a context sensitive half-time of 3 min and an elimination half-life < or = 10 min. This study sought to evaluate the efficacy of remifentanil and propofol total intravenous anesthesia (TIVA) in 161 patients undergoing inpatient surgery. Remifentanil 1 microgram/kg was given intravenously (i.v.) followed by one of two randomized infusion rates: small dose (0.5 micrograms.kg-1.min-1) or large dose (1 microgram.kg-1.min-1). Propofol (0.5-1.0 mg/kg i.v. bolus and 75 micrograms.kg-1.min-1 infusion) and vecuronium were also given. Remifentanil infusions were decreased by 50% after tracheal intubation. End points included responses (hypertension, tachycardia, and somatic responses) to tracheal intubation and surgery. More patients in the small-dose than in the large-dose group responded to tracheal intubation with hypertension and/or tachycardia (25% vs 6%; P = 0.003) but there were no other differences between groups in intraoperative responses. Recovery from anesthesia was within 3-7 min in both groups. The most frequent adverse events were hypotension (systolic blood pressure [BP] < 80 mm Hg or mean BP < 60 mm Hg) during anesthesia induction (10% small-dose versus 15% large-dose group; P = not significant [NS]) and hypotension (27% small-dose versus 30% large-dose group; P = NS), and bradycardia (7% small-dose versus 19% large-dose group; P = NS) during maintenance. In conclusion, when combined with propofol 75 micrograms.kg-1.min-1, remifentanil 1 microgram/kg i.v. as a bolus followed by an infusion of 1.0 microgram.kg-1.min-1 effectively controls responses to tracheal intubation. After tracheal intubation, remifentanil 0.25-4.0 micrograms.kg-1.min-1 effectively controlled intraoperative responses while allowing for rapid emergence from anesthesia.
authors.affiliation: Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
authors.forename: C W
authors.initials: CW
authors.lastname: Hogue
authors.forename: T A
authors.initials: TA
authors.lastname: Bowdle
authors.forename: C
authors.initials: C
authors.lastname: O'Leary
authors.forename: D
authors.initials: D
authors.lastname: Duncalf
authors.forename: R
authors.initials: R
authors.lastname: Miguel
authors.forename: M
authors.initials: M
authors.lastname: Pitts
authors.forename: J
authors.initials: J
authors.lastname: Streisand
authors.forename: G
authors.initials: G
authors.lastname: Kirvassilis
authors.forename: B
authors.initials: B
authors.lastname: Jamerson
authors.forename: S
authors.initials: S
authors.lastname: McNeal
authors.forename: R
authors.initials: R
authors.lastname: Batenhorst
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000493:pharmacokinetics; D000762:Anesthesia Recovery Period; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D017558:Elective Surgical Procedures; D005260:Female; D006207:Half-Life; D006339:Heart Rate / Q000187:drug effects; D006760:Hospitalization; D006801:Humans; D007262:Infusions, Intravenous; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D010880:Piperidines / Q000008:administration & dosage* / Q000493:pharmacokinetics; D015742:Propofol / Q000008:administration & dosage*; D011957:Receptors, Opioid / Q000819:agonists; D000077208:Remifentanil; D014673:Vecuronium Bromide / Q000008:administration & dosage
chemical_list: D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D010880:Piperidines; D011957:Receptors, Opioid; D014673:Vecuronium Bromide; D000077208:Remifentanil; D015742:Propofol